GREEN HOME: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- GREEN HOME (EIN 24-0804365)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-15
- IRS object ID
- 201801359349303790
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-15T11:27:33-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis Street Suite 200 | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 65806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240804365 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Green Home | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREE | BusinessNameControlTxt |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Ave | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President/CFO | PersonTitleTxt |
| Phone | 5703213175 | PhoneNum |
| Signature | 2018-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Steven P Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,024,298 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | The Green Home is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna 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 world class health system. Our values are putting patients first, sharing ownership and being servant leaders. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 113 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $660 | PYContributionsGrantsAmt |
| CY Contributions Grants | $36,367 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,760,546 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,980,230 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,021 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,701 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,547 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $10,775,774 | PYTotalRevenueAmt |
| CY Total Revenue | $11,024,298 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,642,272 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,801,592 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,152,155 | PYOtherExpensesAmt |
| CY Other Expenses | $5,965,257 | CYOtherExpensesAmt |
| PY Total Expenses | $11,794,427 | PYTotalExpensesAmt |
| CY Total Expenses | $11,766,849 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,018,653 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$742,551 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,020,382 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,719,900 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,288,534 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $25,472,922 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,731,848 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,246,978 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The Green Home is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna 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 world class health system. Our values are putting patients first, sharing ownership and being servant | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,552,160 | ExpenseAmt |
| Revenue | $10,980,230 | RevenueAmt |
| Desc | The Green Home operated a 120-bed skilled nursing facility that provided both long-term care and short-term services for residents. Services provided include round-the-clock professional nursing; physical, occupational, and speech rehabilitation services; medical social work and counseling services; nutrition services; podiatry services; radiology services; dentistry; and a variety of activities and recreational programs.The average daily census was 108. The payor mix was 73% Medicaid, 16% Medicare and 11% self-pay residents. Rehabilitation services provided included 14,857 physical therapy treatments, 16,709 occupational therapy treatments and 3,239 speech therapy treatments. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $636,187 | ExpenseAmt |
| Revenue | $806,680 | RevenueAmt |
| Desc | The Green Home operated The Laurels, a 30 unit personal care home serving individuals aged 62 and older. The Laurels had an occupancy rate of 82% with 100% self pay residents. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $11,188,347 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 113 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eric D Pohjala | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 Meade St Ste U-6 | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Lisa V Feil PsyD | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Robert P Fitzgerald | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Harold F Hoose II | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Michael W Lichty | ||||||||||
| Director | 0.33 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| Dennis Murray PhD | ||||||||||
| Director | 0.33 | 13.67 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas M Owlett Esq | ||||||||||
| Chairman | 0.33 | 13.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Glenn B Poirer | ||||||||||
| Vice Chairman | 0.33 | 13.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Wendy S Swartz CPA | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Aneurin J Williams Jr | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Donna R Wilson | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Kathy J Wright PhD | ||||||||||
| Secretary | 0.33 | 3.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Jill A Burns MD | ||||||||||
| Chairman | 0.33 | 49.67 | Yes (X) | $0 | $259,810 | $33,044 | ||||
| Walter J Laibinis DO | ||||||||||
| Vice Chairman | 0.33 | 43.67 | Yes (X) | $0 | $414,730 | $30,151 | ||||
| Steven P Johnson | ||||||||||
| President/CEO | 0.33 | 49.67 | Yes (X) | $0 | $960,096 | $33,271 | Yes (X) | |||
| David Lopatofsky MD | ||||||||||
| Exec VP/CMO | 1.00 | 40.00 | $0 | $593,514 | $37,048 | Yes (X) | ||||
| Eric D Pohjala | ||||||||||
| Exec VP/CFO | 1.00 | 42.00 | $0 | $430,438 | $32,395 | Yes (X) | ||||
| Jan EFisher | ||||||||||
| Exec VP/COO | 0.33 | 43.67 | $0 | $551,981 | $31,238 | Yes (X) | ||||
| Janie Hilfiger | ||||||||||
| President/SSMH | 1.00 | 42.00 | $0 | $186,187 | $18,391 | Yes (X) | ||||
| Jacqueline B Werts | ||||||||||
| Director Nursing Home Admi | 40.00 | $118,612 | $0 | $6,754 | Yes (X) | |||||
| Aliscia Shafer | ||||||||||
| Supvisor RN/Hospital/LTC | 40.00 | $104,176 | $0 | $13,560 | Yes (X) | |||||
| Daisy Bova | ||||||||||
| Supvisor RN/Hospital/LTC | 40.00 | $105,480 | $0 | $15,644 | Yes (X) | |||||
| Ronald J Bulter Retired | ||||||||||
| Former Exec VP/CBO (retire | 0.00 | 2.00 | $0 | $335,670 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $328,268 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,732,426 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $251,496 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Genesis Eldercare Rehab | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 East State St | AddressLine1Txt |
| City | Kennett Square | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19348 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Rehabilitation Services | ServicesDesc |
| Compensation | $732,162 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $36,367 | RelatedOrganizationsAmt |
| Total Contributions | $36,367 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Skilled Nursing Care | 623000 | $10,153,204 | $10,153,204 |
| Personal Care Home | 623000 | $804,280 | $804,280 |
| Bad Debt Recovery | 623000 | $10,936 | $10,936 |
| Employee & Guest Meals | 722210 | $6,824 | $6,824 |
| Beauty Shop | 812900 | $4,986 | $4,986 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,980,230 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,701 | TotalRevenueColumnAmt |
| Exclusion | $7,701 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,024,298 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,980,230 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,701 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,490,910 | TotalAmt |
| Program Services | $4,253,138 | ProgramServicesAmt |
| Management And General | $237,772 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,952 | TotalAmt |
| Program Services | $180,952 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $802,142 | TotalAmt |
| Program Services | $800,943 | ProgramServicesAmt |
| Management And General | $1,199 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $327,588 | TotalAmt |
| Program Services | $310,656 | ProgramServicesAmt |
| Management And General | $16,932 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,601 | TotalAmt |
| Program Services | $415,601 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190 | TotalAmt |
| Management And General | $190 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,359,403 | TotalAmt |
| Program Services | $3,065,578 | ProgramServicesAmt |
| Management And General | $293,825 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,300 | TotalAmt |
| Program Services | $3,196 | ProgramServicesAmt |
| Management And General | $3,104 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,058 | TotalAmt |
| Program Services | $40,279 | ProgramServicesAmt |
| Management And General | $2,779 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,436 | TotalAmt |
| Program Services | $580 | ProgramServicesAmt |
| Management And General | $856 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,811 | TotalAmt |
| Program Services | $1,372 | ProgramServicesAmt |
| Management And General | $439 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380,149 | TotalAmt |
| Program Services | $380,149 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,380 | TotalAmt |
| Program Services | $41,472 | ProgramServicesAmt |
| Management And General | $1,908 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,119 | TotalAmt |
| Program Services | $6,875 | ProgramServicesAmt |
| Management And General | $3,244 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,028 | TotalAmt |
| Program Services | $2,028 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,649 | TotalAmt |
| Program Services | $409,649 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,770 | TotalAmt |
| Program Services | $85,770 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Resident Care Supplies | $1,198,083 | $1,181,991 | $16,092 |
| Dues | $8,280 | $8,118 | $162 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,766,849 | TotalAmt |
| Program Services | $11,188,347 | ProgramServicesAmt |
| Management And General | $578,502 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250 | BOYAmt |
| EOY | $1,250 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $985,536 | BOYAmt |
| EOY | $382,324 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,549,966 | BOYAmt |
| EOY | $1,728,382 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,518 | BOYAmt |
| EOY | $11,680 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,900 | BOYAmt |
| EOY | $6,077 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,168,921 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,510,948 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,418,188 | BOYAmt |
| EOY | $3,657,973 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,044,024 | BOYAmt |
| EOY | $21,932,214 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,020,382 | BOYAmt |
| EOY | $27,719,900 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,387,942 | BOYAmt |
| EOY | $955,446 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,842 | BOYAmt |
| EOY | $174,449 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,529 | BOYAmt |
| EOY | $88,816 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,650,221 | BOYAmt |
| EOY | $24,254,211 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,288,534 | BOYAmt |
| EOY | $25,472,922 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,731,848 | BOYAmt |
| EOY | $2,246,978 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,731,848 | BOYAmt |
| EOY | $2,246,978 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,020,382 | BOYAmt |
| EOY | $27,719,900 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$742,551 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $257,681 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,225 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,840 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,255 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $660 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $36,367 | CurrentTaxYearAmt |
| Total | $42,347 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,866,886 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,538,292 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,857,087 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,731,412 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,980,230 | CurrentTaxYearAmt |
| Total | $52,973,907 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,868,111 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,541,132 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,858,342 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,732,072 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,016,597 | CurrentTaxYearAmt |
| Total | $53,016,254 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $53,016,254 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $114,578 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,115 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,049 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,021 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,701 | CurrentTaxYearAmt |
| Total | $172,464 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $114,578 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,115 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,049 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,021 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,701 | CurrentTaxYearAmt |
| Total | $172,464 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,982,689 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,566,247 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,870,391 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,745,093 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,024,298 | CurrentTaxYearAmt |
| Total | $53,188,718 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99680 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99690 | PublicSupportPY509Pct |
| Investment Income CY | 0.00320 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00310 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $305,800 | BeginningYearBalanceAmt |
| Contributions | -$335,097 | ContributionsAmt |
| Investment Earnings Or Losses | $29,815 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $518 | AdministrativeExpensesAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $272,788 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $34,234 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,222 | AdministrativeExpensesAmt |
| End Year Balance | $305,800 | EndYearBalanceAmt |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $318,358 | OtherCostOrOtherBasisAmt |
| Book Value | $318,358 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,011,842 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,779,737 | DepreciationAmt |
| Book Value | $2,232,105 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,477,130 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,523,309 | DepreciationAmt |
| Book Value | $953,821 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $361,591 | OtherCostOrOtherBasisAmt |
| Depreciation | $207,902 | DepreciationAmt |
| Book Value | $153,689 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,657,973 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due to/from affiliates | $21,898,121 |
| Due to/from 3rd parties | $34,093 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $21,932,214 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Exempt Affiliates | Desc |
| Amt | $24,254,211 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $24,254,211 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | Security deposits and personal care account funds |
| Part V, Line 4: | The endowment funds are used to fund the mission of the organization. |
| Part X Line 2 | The System companies, with the exception of SVI, CB, SHSIN, TMSO and TCN, have been recognized as exempt from imcome taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However these entites are subject to federal income tax on any unrelated business taxable income. SVI, CB, SHSIN, TMSO and TCN account for income in accordance with income tax accounting guidance (ASC 740 Income Taxes). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jill A Burns MD | ||||||||||||||
| Chairman | $0 | $224,371 | $0 | $34,600 | $0 | $839 | $0 | $9,950 | $0 | $23,094 | $0 | $292,854 | $0 | $0 |
| Walter J Laibinis DO | ||||||||||||||
| Vice Chairman | $0 | $229,365 | $0 | $173,818 | $0 | $11,547 | $0 | $9,950 | $0 | $20,201 | $0 | $444,881 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| President/CEO | $0 | $703,292 | $0 | $226,453 | $0 | $30,351 | $0 | $13,925 | $0 | $19,346 | $0 | $993,367 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $0 | $425,773 | $0 | $141,731 | $0 | $26,010 | $0 | $11,275 | $0 | $25,773 | $0 | $630,562 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $362,196 | $0 | $66,436 | $0 | $1,806 | $0 | $9,950 | $0 | $22,445 | $0 | $462,833 | $0 | $0 |
| Jan EFisher | ||||||||||||||
| Exec VP/COO | $0 | $401,814 | $0 | $138,186 | $0 | $11,981 | $0 | $9,950 | $0 | $21,288 | $0 | $583,219 | $0 | $0 |
| Janie Hilfiger | ||||||||||||||
| President/SSMH | $0 | $160,329 | $0 | $21,609 | $0 | $4,249 | $0 | $7,416 | $0 | $10,975 | $0 | $204,578 | $0 | $0 |
| Ronald J Bulter Retired | ||||||||||||||
| Former Exec VP/CBO (retire | $0 | $0 | $0 | $0 | $0 | $335,670 | $0 | $0 | $0 | $0 | $0 | $335,670 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 Schedule J Part I Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board |
| Form 990 Schedule J Part I Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2016, the minimum threshold was met that would trigger VCIP payments. In September 2016, President/CEO Steven P. Johnson received a variable compensation award in the amount of $226,453. |
| Part I, Line 4a | Ronald J. Butler, Former Exec VP/CBO retired on 4/15/15. His entire reportable compensation, $335,670 paid by a related organization, is a severance payment. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna, 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 Entity shall be managed and controlled by the Board of Directors, subject to the oversight of the sole Member, UPMC Susquehanna, of the management and operation of the Entity, except that the following powers are reserved exclusively to the sole Member of the Entity, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effect whatsoever. The sole Member shall exercise its powers through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A) to appoint or elect the directors B) to appoint and remove the President following consultation with the Entity C) to approve the nominees for elected officers and to return the list of approved nominees to the governing bodies for election D) to remove, with or without cause, any director or any elected officer E) to amend the Governing Instruments and to approve all amendments to the Governing Instruments which are proposed for adoption F) to approve the annual operating and capital budgets G) to establish requirements for unified budget H) to approve the incurrence or issuance of debt proposed by Entity and the encumbrance of any Entity assets to secure any such incurred debt I) to incur debt (or to cause debt to be incurred) on behalf of the Entity J) to require contributions in cash or cash equivalents to support the working capital needs or capital projects of any one or more System Entities K) to require that any debt incurred on a System wide basis by or at the direction of UPMC Susquehanna shall be the joint and several obligation of each System Entity L) to direct or approve any cash contributions or any other capital contributions made by one System Entity to another System Entity M) to allocate any financial resources in such manner as UPMC Susquehanna determines to be necessary N) to approve the sale, transfer or other disposition of Entity or Entity property unless it is made in the ordinary course of business or involves assets with a fair market value of less than one hundred dollars O) to direct the transfer of property from the Entity to one or more other System Entities P) to approve of any investment of assets by Entity not within the limits of the System's approved investment policy Q) to establish requirements for the approval of the acquisition, purchase, sale, transfer, encumbrance, leasing, construction or demolition of land or buildings outside the ordinary course of business R) to approve any decision with respect to the addition, modification or discontinuance of any patient care or diagnostic program or health care service Entity to add, modify, relocate or discontinue any patient care or diagnostic program or health care service U) to approve or direct any merger, consolidation, organization, reorganization, joint venture, corporate division, sale conversion, lease or exchange of substantially all the assets, dissolution, liquidation or any other modification of corporate structure or affiliations affecting the autonomy, governance, or operations, and the creation or acquisition of any new affiliate by Entity V) to dissolve or terminate the existence of Entity and to determine the distribution of assets upon such termination or dissolution W) to coordinate managed care plans involving Entity on behalf of Entity. |
| Form 990, Part VI, Section B, line 11b | A high-level overview of Forms 990 is presented to the parent Board of Directors (UPMC Susquehanna, #23-2751183) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | Annually on the 1st day of January, the UPMC Susquehanna CEO sends to all Directors, Officers, Management staff and contracted physicians a questionnaire to be completed and returned by January 15. A report is submitted to the Board of Directors to notify them of any conflicts of interest disclosed. |
| Form 990, Part VI, Section B, line 15 | On a bi-annual basis an independent compensation consulting firm performs an analysis of the Leadership salary structure in relationship to the labor market using data from four different salary surveys. Their analysis is reviewed with the Governance Committee of the Board of Directors. The firm then outlines its recommendations for the proposed executive salary structure to the Committee for their consideration and approval. |
| Form 990, Part VI, Section C, line 19 | Governing documents and financial statements are available to the public upon request. The conflict of interest policy is also available to the public. |
| Form 990, Part IX, line 11g | Other Fees: Program service expenses 3065578. Management and general expenses 293825. Fundraising expenses 0. Total expenses 3359403. |
| Form 990, Part XI, line 9: | Pension Liability Adjustment 89431. Transfers between related entities 168250. |
| Form 990 Part XII Line 2c | The organization did not change its oversight or selection process. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (51 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| UPMC | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251423657 | Healthcare | PA | 501 (c) (3) | Line 12c, III-FI | UPMC | Yes (1) | |
| Pittsburgh Lifetime Care Community | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251335247 | Management consulting and supervisory services | PA | 501 (c) (3) | Line 10 | UPMC SR COMM | Yes (1) | |
| Canterbury Place | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 250965334 | Sr. Living | PA | 501 (c) (3) | Line 10 | UPMC SR COMM | Yes (1) | |
| Seneca Place | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 721562844 | Sr. Living | PA | 501(c)(3) | Line 10 | UPMC SR COMM | Yes (1) | |
| Shadyside Hospital Supporting Foundation | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 260303394 | Foundation | PA | 501 (c) (3) | Line 12a, I | UPMC | Yes (1) | |
| UPMC Lee | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 250613830 | Inactive | PA | 501 (c) (3) | Line 3 | UPMC | Yes (1) | |
| Pittsburgh Care Partnership Inc | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251753852 | Adultdaycare | PA | 501 (c) (3) | Line 10 | UPMC | Yes (1) | |
| UPMC Center For High Value Healthcare | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 452178782 | Research | PA | 501 (c) (3) | Line 7 | UPMC | Yes (1) | |
| Shadyside Hospital Foundation | |||||||||||
| 532 South Aiken Avenue | Pittsburgh | PA | 15232 | 251290546 | Foundation | PA | 501 (c) (3) | Line 12c, III-FI | UPMC Presby | Yes (1) | |
| Passavant Hospital Foundation | |||||||||||
| 9100 Babcock Blvd | Pittsburgh | PA | 15237 | 251407815 | Foundation | PA | 501 (c) (3) | Line 12b, II | UPMC Pass | Yes (1) | |
| UPMC Northwest Foundation | |||||||||||
| 100 Farfield Drive | Seneca | PA | 16346 | 251483624 | Foundation | PA | 501 (c) (3) | Line 12d, III-O | UPMC Northwest | Yes (1) | |
| St Margaret Foundation | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251520340 | Foundation | PA | 501 (c) (3) | Line 7 | UPMC St Marg | Yes (1) | |
| Children's Hospital of Pittsburgh FND | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251865744 | Foundation | PA | 501 (c) (3) | Line 7 | UPMC CHP | Yes (1) | |
| Magee-women Res Inst and Foundation | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251462311 | Foundation | PA | 501 (c) (3) | Line 7 | 0 | N/A | |
| UPMC Kane | |||||||||||
| 4372 Route 6 | Pittsburgh | PA | 16735 | 250998168 | Hospital | PA | 501 (c) (3) | Line 3 | UPMC Hamot | 0 | |
| Great Lakes Physician Practice | |||||||||||
| 600 Grant Street 58th Floor | Pittsburgh | PA | 15219 | 464186362 | Physicians | NY | 501(c)(3) | Line 3 | Regnl Health | Yes (1) | |
| Hamot Health Foundation | |||||||||||
| 302 French St | Erie | PA | 16507 | 251400999 | Foundation | PA | 501(c)(3) | Line 12b, II | UPMC Hamot | Yes (1) | |
| Safe Harbor Behavorial Health of UPMC HA | |||||||||||
| 1330 W 26th St | Erie | PA | 16508 | 251317492 | Behavorial | PA | 501(c)(3) | Line 7 | UPMC Hamot | Yes (1) | |
| UPMC Jameson | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 250965406 | Healthcare | PA | 501(c)(3) | Line 3 | UPMC | Yes (1) | |
| Jameson Healthcare Foundation | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 251536037 | Foundation | PA | 501(c)(3) | Line 12b, II | UPMC Jameson | Yes (1) | |
| Jameson Health Services Inc | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 030486993 | Healthcare | PA | 501(c)(3) | Line 12b, II | UPMC Jameson | Yes (1) | |
| Children's Advocacy Center of Lawrence | |||||||||||
| 1107 Wilmington ave | New Castle | PA | 16105 | 251581304 | Support Sys | PA | 501(c)(3) | Line 7 | UPMC Jameson | Yes (1) | |
| UPMCJameson Cancer Center | |||||||||||
| 600 Grant Street 58th FLoor | Pittsburgh | PA | 15219 | 201459415 | Oncology Svc | PA | 501(c)(3) | Line 10 | UPMC Jameson | Yes (1) | |
| Jameson Medical Care Inc | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 260462696 | Healthcare | PA | 501(c)(3) | Line 10 | UPMC Jameson | Yes (1) | |
| Jameson Care Center Inc | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 232871396 | Healthcare | PA | 501(c)(3) | Line 10 | UPMC SR COMM | Yes (1) | |
| UPMC Susquehanna | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232751183 | Healthcare | PA | 501(c)(3) | Line 12b, II | UPMC | Yes (1) | |
| Venango VNA Foundation | |||||||||||
| 491 Allegheny Boulevard | Franklin | PA | 16323 | 251472179 | Foundation | PA | 501(c)(3) | Line 12d, III-O | UPMC Visiting | Yes (1) | |
| Divine Providence Hospital of the Sister | |||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 240799343 | Healthcare | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| Susquehanna Physician Services | |||||||||||
| 1201 grampian boulevard | williamsport | PA | 17701 | 232449454 | Physician Svc | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| Susquehanna Health System Innovation CTR | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Healthcare | PA | 501(c)(3) | Line 12a, I | UPMC Susquehanna | Yes (1) | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Boulevard | Williamsport | PA | 17701 | 232743470 | Fundraising | PA | 501(c)(3) | Line 12a, I | UPMC Susquehanna | Yes (1) | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | HOspital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| Laurel Realty Inc | |||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 231403678 | Rental Real Estate | PA | 501(c)(2) | UPMC Susquehanna | Yes (1) | ||
| Laurel Management Services Inc | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251644910 | Management Svc | PA | 501(c)(3) | Line 12b, II | UPMC Susquehanna | Yes (1) | |
| Laurel Health System | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 240795488 | Healthcare | PA | 501(c)(3) | Line 12b, II | UPMC Susquehanna | Yes (1) | |
| Muncy Valley Hospital | |||||||||||
| 215 East Water Street | Muncy | PA | 17756 | 240806023 | Healthcare | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| Soldiers & Sailors Memorial Hospital | |||||||||||
| 32-36 Cental Ave | Wellsboro | PA | 16901 | 240804365 | Healthcare | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| Tioga Health Care Providers | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251765538 | Healthcare | PA | 501(c)(3) | Line 12b, II | UPMC Susquehanna | Yes (1) | |
| Williamsport Area Ambulance Service Coop | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance Svc | PA | 501(c)(3) | Line 10 | Williamsport Hospital | Yes (1) | |
| UPMC Susquehanna Lock Haven | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 821600494 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| UPMC Susquehanna Sunbury | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 821592230 | Hospital | PA | 501(c)(3) | Line 3 | UPMC Susquehanna | Yes (1) | |
| UPMC Chautauqua at WCA | |||||||||||
| 207 Foote Avenue | Jamestown | NY | 14701 | 160743226 | Hospital | NY | 501(c)(3) | Line 3 | UPMC Chautauqua | Yes (1) | |
| WCA Group Inc | |||||||||||
| 207 Foote Avenue | Jamestown | NY | 14701 | 222392582 | Holding Co | NY | 501(c)(3) | Line 12b, II | UPMC Chautauqua | Yes (1) | |
| Starflight Inc | |||||||||||
| 135 Allen Street | Jamestown | NY | 14701 | 161557878 | Stat Medvac | NY | 501(c)(3) | Line 7 | UPMC Chautauqua | Yes (1) | |
| South Central Alpha Housing and Healthcare | |||||||||||
| 3410 w Pittsburgh Road | New Castle | PA | 16101 | 251701701 | Skilled Nursing | PA | 501(c)(3) | Line 10 | UPMC SR COMM | Yes (1) | |
| South Western Alpha Housing and Healthcare | |||||||||||
| 745 Greenville Road | Mercer | PA | 16137 | 251701700 | Skilled Nursing | PA | 501(c)(3) | Line 10 | UPMC SR COMM | Yes (1) | |
| Kane Community Hospital Foundation | |||||||||||
| 4372 Route 6 | Kane | PA | 16735 | 263906925 | Foundation | PA | 501(c)(3) | Line 7 | UPMC Kane | Yes (1) | |
| Junior GUild o fthe Jameson Memorial Hospital | |||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 256005313 | Support | PA | 501(c)(3) | Line 12d, III-O | UPMC Jameson | Yes (1) | |
| Laurel Health Foundation | |||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 251810488 | Foundation | PA | 501(c)(3) | Line 12b, II | UPMC Susquehanna | Yes (1) | |
| WCA Foundation Inc | |||||||||||
| 300 Foote Avenue PO Box 840 | Jamestown | NY | 14702 | 222393584 | Foundation | PA | 501(c)(3) | Line 12c, III-FI | UPMC Chautauqua | Yes (1) | |
| UPMC Senior Communities Inc | |||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251574736 | Sr. Living | PA | 501(c)(3) | Line 10 | UPMC | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Seneca Hills Assisted living | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 232873106 | Assisted Living | PA | N/A | N/A | 0 | 0 |
| St Margaret Medical Arts Asso | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251786655 | Med Office BL | PA | N/A | N/A | 0 | 0 |
| Core Network LLC | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251786209 | Healthcare | PA | N/A | N/A | 0 | 0 |
| Life Home Care LP | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251847839 | Homecare | PA | N/A | N/A | 0 | 0 |
| Core Network LLC | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251608318 | Med Office BL | PA | N/A | N/A | 0 | 0 |
| Chartwell PA LP | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251729714 | Homehealth | PA | N/A | N/A | 0 | 0 |
| Life Care home Srv of NW PA | ||||||||||
| 1647 Sassafras Street | Erie | PA | 16501 | 251536879 | Home Health | PA | N/A | N/A | 0 | 0 |
| Hamot-KCH Estate Venture | ||||||||||
| 300 State Street | Erie | PA | 16507 | 263691782 | Medical Office | PA | N/A | N/A | 0 | 0 |
| Hamot Surgery Center LLC | ||||||||||
| 200 State Street | Erie | PA | 16507 | 251863661 | Ambulatory SU | PA | N/A | N/A | 0 | 0 |
| EPN-HAmot Urgent Care LLC | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 272147949 | Urgent Care | PA | N/A | N/A | 0 | 0 |
| Mountain View Medical Oncology | ||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 461449241 | Healthcare | PA | N/A | N/A | 0 | 0 |
| Lawrence County MRI & Diagnostics | ||||||||||
| 2526 Wilmington Ave | New Castle | PA | 16105 | 270219891 | Imaging Center | PA | N/A | N/A | 0 | 0 |
| Community Basket LLC | ||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 201195739 | Real Estate Rental | PA | N/A | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (65 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Renaissance Family Practice - UPMC INC | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 262942406 | Healthcare | PA | N/A | C | 0 | ||||
| UPMC Holding Company INC | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251777713 | Holding Corp | PA | N/A | C | 0 | ||||
| UPMC Coverage Products INC | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251777710 | Holding Corp | PA | N/A | C | 0 | ||||
| Freedom Insurance Company | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 030308944 | Insurance | VT | N/A | C | 0 | ||||
| Tri-Century Insurance Co | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251500739 | Insurance | PA | N/A | C | 0 | ||||
| UPMC DNA Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251883237 | Insurance | PA | N/A | C | 0 | ||||
| UPMC Health Benefits Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251844144 | health Insurance | PA | N/A | C | 0 | ||||
| UPMC Health Network Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 721527566 | Health Insurance | PA | N/A | C | 0 | ||||
| UPMC Health Plan Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 232813536 | HealtH Insurance | PA | N/A | C | 0 | ||||
| UPMC Benefit Management Services Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251769564 | Workers' Comp | PA | N/A | C | 0 | ||||
| UPMC Diversified Services Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251778454 | Holding Corp | PA | N/A | C | 0 | ||||
| Monroeville Specialty Clinic | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251666087 | HealtH Insurance | PA | N/A | C | 0 | ||||
| Medical Archival Systems Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 232912501 | Software Development | DE | N/A | C | 0 | ||||
| Presby Health Resource Mgmt | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251422155 | Healthcare | PA | N/A | C | 0 | ||||
| RX Partners Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251801966 | Retail Pharmacy | PA | N/A | C | 0 | ||||
| Biotronics | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251843500 | Equip Maintenance | PA | N/A | C | 0 | ||||
| Medical center properties Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251796940 | Real Estate | PA | N/A | C | 0 | ||||
| Askesis Development group Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 541625585 | Software Development | DE | N/A | C | 0 | ||||
| Panther reinsurance Company LTD | |||||||||||||
| Insurance | N/A | C | 0 | PO Box 1109 | Grand Cayman Isla | CJ | CJ | ||||||
| Forbes Reinsurance Comapny LTD | |||||||||||||
| Insurance | N/A | C | 0 | PO Box 1109 | Grand Cayman Isla | CJ | CJ | ||||||
| Askesis Development group Inc | |||||||||||||
| Insurance | N/A | C | 0 | PO Box 1109 | Grand Cayman Isla | CJ | CJ | ||||||
| UPMC International Health Initiatives | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 841706741 | Inactive | PA | N/A | C | 0 | ||||
| UPMC Ireland Limited | |||||||||||||
| Healthcare Su | N/A | C | 0 | 6th Floor Beacon Hospital Sandyford | Dublin | EI | EI | ||||||
| UPMC United Kingdom LTD | |||||||||||||
| 980571026 | Software Lice | N/A | C | 0 | C/O NairCO 11th Floor Whitefriars | Bristol | UK | UK | |||||
| Bayfront Regional Development Corp | |||||||||||||
| 300 State Street | Erie | PA | 16507 | 251401388 | Re Holding Co | PA | N/A | C | 0 | ||||
| Bayside Development Corp | |||||||||||||
| 300 State Street | Erie | PA | 16507 | 251401386 | Real Estate | PA | N/A | C | 0 | ||||
| UPMC Work Alliance Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 452825053 | Insurance | PA | N/A | C | 0 | ||||
| UPMC Canada Technologies Limited | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | SOftware | N/A | C | 0 | CA | |||||
| Allied Orthopedics Appliances INc | |||||||||||||
| 335 E 3rd St | Jamestown | NY | 14701 | 161092951 | Med Appliances | PA | N/A | C | 0 | ||||
| UPMC Health Coverage Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 462824537 | Insurance | PA | N/A | C | 0 | ||||
| UPMC Health Options Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 462824626 | Insurance | PA | N/A | C | 0 | ||||
| UPMC Complete Care Inc | |||||||||||||
| 5215 Centre Avenue | Pittsburgh | PA | 15232 | 463605753 | Healhcare | PA | N/A | C | 0 | ||||
| American Home Health Services | |||||||||||||
| 868 Corporate way | Westlake | OH | 44145 | 311521422 | Home Health Services | OH | N/A | C | 0 | ||||
| Health Fidelity Inc | |||||||||||||
| 210 S B St | San Mateo | CA | 94401 | 452538963 | Technology Sv | CA | N/A | C | 0 | ||||
| Fluence Health Inc | |||||||||||||
| 6425 Penn Ave | Pittsburgh | PA | 15206 | 472684174 | Software | DE | N/A | C | 0 | ||||
| Cuvrai health Inc | |||||||||||||
| 6425 Penn Ave | Pittsburgh | PA | 15206 | 811217377 | Healhcare | DE | N/A | C | 0 | ||||
| Pensiamo Inc | |||||||||||||
| 600 Grant Street 59th Floor | Pittsburgh | PA | 15219 | 812069236 | Supply Chain | DE | N/A | C | 0 | ||||
| Altoona Family Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251444935 | Mgmt Svcs | PA | N/A | C | 0 | ||||
| Lexington Holdings Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251794386 | Medical Svcs | PA | N/A | C | 0 | ||||
| Lexington One Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251468889 | Rental | PA | N/A | C | 0 | ||||
| Lexington Two Inc | |||||||||||||
| Howard Ave 7th St | Altoona | PA | 16601 | 251555689 | Rental Eqpt | PA | N/A | C | 0 | ||||
| Lexington Four Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251793736 | Holding Corp | PA | N/A | C | 0 | ||||
| Allegheny Healthcare Staffing Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 271657362 | Employment Sv | PA | N/A | C | 0 | ||||
| UPMC Altoona Regional Health Services | |||||||||||||
| 1414 9th Ave | Altoona | PA | 16602 | 251219302 | Medical Svcs | PA | N/A | C | 0 | ||||
| Lexington Anesthesia Associates inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251897765 | Medical Svcs | PA | N/A | C | 0 | ||||
| Northern Cambria Medical Center Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251530860 | Medical Svcs | PA | N/A | C | 0 | ||||
| Patton Family Medical Center Inc | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 251793735 | Medical Svcs | PA | N/A | C | 0 | ||||
| MEDCPU | |||||||||||||
| 100 Wall Street Suite 2202 | New York | NY | 10005 | 383805381 | Software Development | DE | N/A | C | 0 | ||||
| UPMC Excess PL TR | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 826254351 | Trust | PA | N/A | T | 0 | ||||
| Rxante Inc | |||||||||||||
| 511 Congress Street 803 | Portland | ME | 04101 | 454040219 | Medication MGT | DE | N/A | C | 0 | ||||
| Vincent Payment Solutions Inc | |||||||||||||
| bakery Square 6425 Penn Avenue STE | Pittsburgh | PA | 15206 | 821101143 | Payment System | DE | N/A | C | 0 | ||||
| J Health Ventures Inc | |||||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 251607893 | Inactive | PA | N/A | C | 0 | ||||
| JER Medical Associates Inc | |||||||||||||
| 1211 Wilmington Ave | New Castle | PA | 16105 | 251609398 | Inactive | PA | N/A | C | 0 | ||||
| Susquehanna Health System Insurance Net | |||||||||||||
| 980458722 | Inactive | N/A | C | 0 | PO Box 1159 | Grand Cayman Isla | CJ | CJ | |||||
| Susquehanna Ventures Inc | |||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470623 | Pharmacy | PA | N/A | C | 0 | ||||
| Tyoga Carenet | |||||||||||||
| 114 East Ave | Wellsboro | PA | 16901 | 251810967 | Integrate Healthcare | PA | N/A | C | 0 | ||||
| WCA Service Corporation Inc | |||||||||||||
| 207 Foote Ave | Jamestown | NY | 14701 | 161151438 | NY | N/A | C | 0 | |||||
| Friends of Altoona Hospital | |||||||||||||
| 620 Howard Ave | Altoona | PA | 16601 | 861140504 | Fundraising | PA | N/A | C | 0 | ||||
| HC Pharmacy Central Inc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251364192 | Pharmacy CO-OP | PA | N/A | C | 0 | ||||
| Children's Community Care | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251781887 | Pediatric Svc | PA | N/A | C | 0 | ||||
| UPMC Cancer Centers Ireland Limited | |||||||||||||
| Cancer Treatment | N/A | C | 0 | 6th Floor Beacon Hospital Sandyford | Dublin | EI | EI | ||||||
| UPMC Physician Services Holding | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251877017 | Holding Corp | PA | N/A | C | 0 | ||||
| Hematology Oncology Assoc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 421648357 | Healhcare | PA | N/A | C | 0 | ||||
| Oncology Hematology Assoc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251762980 | Healhcare | PA | N/A | C | 0 | ||||
| Tri-State Neurosurgical Assoc | |||||||||||||
| 600 Grant Street | Pittsburgh | PA | 15219 | 251458655 | Healhcare | PA | N/A | C | 0 | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule R, Part IV | Susquehanna health System Insurance Network, LTD (SHSIN) EIN#98-0458722, is a foreign corporation, incorporated under the laws of Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN had been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna EIN#23-2751183, is a 501(C)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US Federal income tax. |
| Schedule R, Parts II-IV | The entities marked with an asterisk are not technically "related parties," as defined by the IRS Form 990 instructions, of the filing organization. However, they are listed on Schedule R to reflect that they are part of the UPMC system of entities, as they all share UPMC as their ultimate parent corporation. |