THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA (EIN 23-0794160)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-10
- IRS object ID
- 201711309349300541
- Schema version
- 2015v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-10T07:47:16-07:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLSPAN HEALTH | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3350 WHITEFORD ROAD | AddressLine1Txt |
| City | YORK | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17403 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 230794160 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOOD SAMARITAN HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOOD | BusinessNameControlTxt |
| Phone | 7178513055 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2767 | AddressLine1Txt |
| City | YORK | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17405 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Michael O'Connor | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | false | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID P RIZZUTO | PreparerPersonNm |
| PTIN | P01210563 | PTIN |
| Phone | 7178513095 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | Kevin Mosser MD | PrincipalOfficerNm |
| Gross Receipts | $182,262,322 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WELLSPAN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1989 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | The Good Samaritan Hospital is a tax-exempt organization dedicated to providing high-quality, compassionate healthcare that improves the overall health of the community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 20 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 1570 | TotalEmployeeCnt |
| Total Volunteers | 290 | TotalVolunteersCnt |
| Total Gross UBI | $3,647,928 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $563,601 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,091,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $474,723 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $181,425,802 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $176,258,293 | CYProgramServiceRevenueAmt |
| PY Investment Income | $681,500 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,499,891 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,227,737 | PYOtherRevenueAmt |
| CY Other Revenue | $2,029,415 | CYOtherRevenueAmt |
| PY Total Revenue | $188,426,039 | PYTotalRevenueAmt |
| CY Total Revenue | $182,262,322 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $13,900 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,975 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $75,332,328 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $84,696,439 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $575,766 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $108,604,723 | PYOtherExpensesAmt |
| CY Other Expenses | $104,572,041 | CYOtherExpensesAmt |
| PY Total Expenses | $183,950,951 | PYTotalExpensesAmt |
| CY Total Expenses | $189,276,455 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $4,475,088 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$7,014,133 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $137,841,236 | TotalAssetsBOYAmt |
| Total Assets EOY | $115,305,046 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $148,071,758 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $142,740,374 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$10,230,522 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$27,435,328 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The Good Samaritan Hospital is a tax-exempt organization dedicated to providing high-quality, compassionate healthcare that improves the overall health of the community. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $146,821,589 | ExpenseAmt |
| Grant | $7,975 | GrantAmt |
| Revenue | $177,440,483 | RevenueAmt |
| Desc | WellSpan Good Samaritan Hospital has been providing powerful medicine and comforting care to the residents of Lebanon County for more than 125 years.As the community hospital of the Lebanon valley region, WellSpan Good Samaritan Hospital offers a wide variety of acute care and outpatient services that help improve the health of our community. The Sechler Family Cancer Center is Lebanon County's first and only integrated cancer center providing medical and radiation oncology in a state of the art facility with a warm and healing environment. The state-of-the-art Cardiac & Vascular Center has won national awards from the American Heart Association. The center has also been designated as a Blue Distinction Center for Cardiac Care by Highmark Blue Shield. Diagnostic and interventional cardiology is offered as well as electrophysiology and open heart surgery. The New Beginning Birth Suites offer a one-stop experience for labor, delivery and recovery in a family-friendly setting. The Good Samaritan Center for Wound Care & Hyperbaric Medicine has created new hope for those with non-healing wounds. Finally, Good Samaritan Hospital offers a network of laboratory and imaging centers around the county of Lebanon.See Attached Federal Supplemental Information: WellSpan Health - 2016 Community Benefit Report | Desc |
| Total Program Service Expenses | $146,821,589 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 111 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 1570 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 20 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID P RIZZUTO | PersonNm |
| Phone | 7178513055 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3350 WHITEFORD ROAD | AddressLine1Txt |
| City | YORK | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 174029081 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Robert Longo | |||||||||
| Pres end 12/15 | 40.00 | 0.00 | Yes (X) | Yes (X) | $932,911 | $0 | $86,178 | ||
| Jane Juppenlatz | |||||||||
| Secr. end 7/15 | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Thomas Harlow | |||||||||
| Pres Beg 06/16 | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Jane Hyde | |||||||||
| Interim Pres. | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $402,389 | $291,826 | ||
| Kevin Mosser | |||||||||
| CEO-WSH | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $1,060,758 | $821,679 | ||
| Dennis Shalters | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Evelyn Colon | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Paul DiGiacomo MD | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Donald Dreibelbis | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert Funk | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert Hoffman | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Frederick Laurenzo | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Robert Phillips | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Galen Weaber | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Bryan Pilkington MD | |||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $627,687 | $45,185 | |||
| Carol Blecker | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| William Schaeffer Jr MD | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Deborah Weaver | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Julie Zinsser | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Kristen O'Shea | |||||||||
| Trustee | 1.00 | 40.00 | Yes (X) | $0 | $329,365 | $62,476 | |||
| John Welch MD | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Frederick Wolfson | |||||||||
| Trustee | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Michael O'Connor | |||||||||
| CFO-WSH | 1.00 | 40.00 | Yes (X) | $0 | $698,953 | $488,337 | |||
| Jacquelyn Gould | |||||||||
| VP of Nursing | 40.00 | 0.00 | $204,824 | $0 | $33,898 | Yes (X) | |||
| Robert Shaver | |||||||||
| VP of Medical Affairs | 40.00 | 0.00 | $354,761 | $0 | $32,738 | Yes (X) | |||
| William Mulligan | |||||||||
| VP-Strategic Planning | 40.00 | 0.00 | $161,423 | $0 | $34,774 | Yes (X) | |||
| Kimberly Feeman | |||||||||
| Senior VP & COO | 40.00 | 0.00 | $318,384 | $0 | $37,490 | Yes (X) | |||
| Robert Richards | |||||||||
| VP Finance & CFO | 40.00 | 0.00 | $352,737 | $0 | $32,882 | Yes (X) | |||
| Randy Litman | |||||||||
| Physician | 40.00 | 0.00 | $248,074 | $0 | $21,522 | Yes (X) | |||
| Daria Kovarikova | |||||||||
| Physician | 40.00 | 0.00 | $206,741 | $0 | $30,294 | Yes (X) | |||
| Byard Yoder | |||||||||
| Physician | 40.00 | 0.00 | $189,056 | $0 | $31,327 | Yes (X) | |||
| Aaron Lane | |||||||||
| Physician | 40.00 | 0.00 | $187,488 | $0 | $19,979 | Yes (X) | |||
| Elizabeth Muhiire-Ntaki | |||||||||
| Physician | 40.00 | 0.00 | $172,853 | $0 | $33,102 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,329,252 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,119,152 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,103,687 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 53 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Lebanon Anesthesia Assoc LTD | |||||
| 110 29th Avenue North Suite 301 | Nashville | TN | 37203 | Anes svcs, Qual Metr | $3,643,068 |
| Lebanon Cardiology Associates | |||||
| 775 Norman Drive | Lebanon | PA | 17042 | Cardiac admin,qual m | $2,181,033 |
| American Healthcare Services Association | |||||
| PO Box 945 | Traverse City | MI | 49685 | Healthcare staffing, | $1,406,927 |
| Diversified Clinical Services | |||||
| PO Box 636981 | Cincinnati | OH | 452636981 | Wound Care Ctr Mgmt | $818,195 |
| Womens Health Center of Leb Ltd | |||||
| 300 Willow Street | Lebanon | PA | 17046 | Call coverage, resid | $565,556 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 24 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $449,493 | RelatedOrganizationsAmt |
| Government Grants | $18,336 | GovernmentGrantsAmt |
| All Other Contributions | $6,894 | AllOtherContributionsAmt |
| Total Contributions | $474,723 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| EHR Incentive Program(MU) | 621500 | $978,208 | $978,208 | |
| Net Patient Services | 621500 | $191,466,188 | $187,818,260 | $3,647,928 |
| W/O- Financial Assistance | 621500 | -$10,013,586 | -$10,013,586 | |
| W/O-Bad Debt | 621500 | -$6,172,517 | -$6,172,517 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $176,258,293 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,460,454 | TotalRevenueColumnAmt |
| Exclusion | $4,460,454 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$975,349 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$975,349 | RelatedOrExemptFuncIncomeAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $279,097 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $279,097 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $279,097 | TotalRevenueColumnAmt |
| Exclusion | $279,097 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $14,786 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $14,786 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,786 | TotalRevenueColumnAmt |
| Exclusion | $14,786 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Cafeteria Sales | 722210 | $678,357 | $678,357 | |
| Management Services | 900099 | $568,128 | $568,128 | |
| Other Operating Revenue | 900099 | $238,511 | $238,511 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $265,322 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $265,322 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,750,318 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,262,322 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $172,817,206 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $3,647,928 | UnrelatedBusinessRevenueAmt |
| Exclusion | $5,322,465 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,975 | TotalAmt |
| Program Services | $7,975 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,540,600 | TotalAmt |
| Management And General | $2,540,600 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,472,150 | TotalAmt |
| Program Services | $50,691,330 | ProgramServicesAmt |
| Management And General | $11,780,820 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,649,579 | TotalAmt |
| Program Services | $4,478,872 | ProgramServicesAmt |
| Management And General | $1,170,707 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,005,296 | TotalAmt |
| Program Services | $5,698,490 | ProgramServicesAmt |
| Management And General | $3,306,806 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,028,814 | TotalAmt |
| Program Services | $4,073,042 | ProgramServicesAmt |
| Management And General | $955,772 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,823 | TotalAmt |
| Management And General | $212,823 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,884 | TotalAmt |
| Management And General | $420,884 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,928 | TotalAmt |
| Management And General | $8,928 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,427,283 | TotalAmt |
| Program Services | $6,149,440 | ProgramServicesAmt |
| Management And General | $702,077 | ManagementAndGeneralAmt |
| Fundraising | $575,766 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,410,677 | TotalAmt |
| Program Services | $8 | ProgramServicesAmt |
| Management And General | $1,410,669 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,381,316 | TotalAmt |
| Program Services | $974,258 | ProgramServicesAmt |
| Management And General | $407,058 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,575,366 | TotalAmt |
| Program Services | $1,303,359 | ProgramServicesAmt |
| Management And General | $272,007 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,378 | TotalAmt |
| Program Services | $70,599 | ProgramServicesAmt |
| Management And General | $36,779 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $147,327 | TotalAmt |
| Program Services | $127,622 | ProgramServicesAmt |
| Management And General | $19,705 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,614,064 | TotalAmt |
| Program Services | $2,614,064 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,168,691 | TotalAmt |
| Program Services | $4,649,851 | ProgramServicesAmt |
| Management And General | $1,518,840 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,042,701 | TotalAmt |
| Program Services | $3,042,701 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Purchased Services | $36,161,624 | $23,535,668 | $12,625,956 |
| Medical Supplies | $31,400,035 | $31,400,035 | |
| Repairs & Maintenance | $6,321,931 | $2,454,337 | $3,867,594 |
| Equipment Rentals | $3,471,905 | $3,471,905 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,699,108 | TotalAmt |
| Program Services | $2,078,033 | ProgramServicesAmt |
| Management And General | $621,075 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,276,455 | TotalAmt |
| Program Services | $146,821,589 | ProgramServicesAmt |
| Management And General | $41,879,100 | ManagementAndGeneralAmt |
| Fundraising | $575,766 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,926 | BOYAmt |
| EOY | $6,276 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,016,900 | BOYAmt |
| EOY | $4,288,749 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,082,853 | BOYAmt |
| EOY | $2,624,001 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,847,380 | BOYAmt |
| EOY | $24,831,214 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $540,242 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,404,122 | BOYAmt |
| EOY | $1,903,412 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,094,902 | BOYAmt |
| EOY | $2,125,505 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $210,657,430 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $146,332,030 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,404,475 | BOYAmt |
| EOY | $64,325,400 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,226,593 | BOYAmt |
| EOY | $7,179,049 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $26,124 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $102,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,217,843 | BOYAmt |
| EOY | $7,893,316 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,841,236 | BOYAmt |
| EOY | $115,305,046 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,482,428 | BOYAmt |
| EOY | $14,940,790 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,578,495 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,794,000 | BOYAmt |
| EOY | $2,431,225 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,113,784 | BOYAmt |
| EOY | $62,917,118 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,681,546 | BOYAmt |
| EOY | $56,872,746 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $148,071,758 | BOYAmt |
| EOY | $142,740,374 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$17,101,000 | BOYAmt |
| EOY | -$34,547,468 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,182,000 | BOYAmt |
| EOY | $6,395,223 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $688,478 | BOYAmt |
| EOY | $716,917 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,230,522 | BOYAmt |
| EOY | -$27,435,328 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,841,236 | BOYAmt |
| EOY | $115,305,046 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$7,014,133 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,331,045 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,859,628 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed Section4955 Tax | false | Form4720FiledSection4955TaxInd |
| Correction Made | false | CorrectionMadeInd |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $8,928 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,928 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1i - Other Activities Description | FormAndLineReferenceDesc |
| Explanation | The hospital holds membership in the American Hospital Association (AHA) and the Hospital & Healthsystem Association of Pennsylvania (HAP) both of which engage in lobbying as a part of their mission to represent the interests of the hospitals at both the federal and state levels. For the year ended 6/30/2016, the amount of dues paid to the HAP totaled $38,818, 23% or $8,928 of which was used for lobbying purposes. On occasion, HAP requests the help of member providers to communicate concerns to legislators regarding pending legislation which could impact hospitals. This can involve direct contact with legislators or letter writing. This occurs infrequently and the cost to the hospital is negligible. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,868,452 | BeginningYearBalanceAmt |
| Contributions | $289,830 | ContributionsAmt |
| Investment Earnings Or Losses | $21,394 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $67,536 | OtherExpendituresAmt |
| End Year Balance | $7,112,140 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,412,227 | BeginningYearBalanceAmt |
| Contributions | $989,598 | ContributionsAmt |
| Investment Earnings Or Losses | $19,671 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,553,044 | OtherExpendituresAmt |
| End Year Balance | $6,868,452 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,073,656 | BeginningYearBalanceAmt |
| Contributions | $3,551,208 | ContributionsAmt |
| Investment Earnings Or Losses | $40,947 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $253,584 | OtherExpendituresAmt |
| End Year Balance | $7,412,227 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,719,409 | BeginningYearBalanceAmt |
| Contributions | $2,252,267 | ContributionsAmt |
| Investment Earnings Or Losses | $54,351 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $952,371 | OtherExpendituresAmt |
| End Year Balance | $4,073,656 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,945,233 | BeginningYearBalanceAmt |
| Contributions | $424,618 | ContributionsAmt |
| Investment Earnings Or Losses | $53,135 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $703,577 | OtherExpendituresAmt |
| End Year Balance | $2,719,409 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.10080 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.89920 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | false | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,468,847 | OtherCostOrOtherBasisAmt |
| Book Value | $1,468,847 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $69,745,933 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,557,060 | DepreciationAmt |
| Book Value | $42,188,873 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $34,178,253 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,356,314 | DepreciationAmt |
| Book Value | $5,821,939 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $104,312,141 | OtherCostOrOtherBasisAmt |
| Depreciation | $90,418,656 | DepreciationAmt |
| Book Value | $13,893,485 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $952,256 | OtherCostOrOtherBasisAmt |
| Book Value | $952,256 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $64,325,400 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (5 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Private Equity, Ltd Partners | $646 | F |
| Real estate, limited partnerships | $1,441 | F |
| Absolute return, Ltd Ptnrs | $1,465 | F |
| Collective mutual funds & inv trusts | $17,724 | F |
| Short Term Investments | $3,672 | F |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Accounts Receivable - Affiliates | |
| Beneficial Interest Trust | $228,588 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $7,893,316 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| Accrued Payroll | $3,396,129 |
| Accrued Payroll w/h | $603,667 |
| Accrued Pension | $44,911,350 |
| Accrued Sales Tax | $14,273 |
| Accrued Vacation | $4,276,979 |
| Due to Affiliates | $1,039,857 |
| Insurance Reserve | $1,198,951 |
| Post Retirement Benefit Obligations | $1,431,540 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $56,872,746 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $178,683,905 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$4,347,731 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$4,347,731 | RevenueNotReportedAmt |
| Revenue Subtotal | $183,031,636 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$769,314 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$769,314 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $182,262,322 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $190,268,063 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $975,349 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $975,349 | ExpensesNotReportedAmt |
| Expenses Subtotal | $189,292,714 | ExpensesSubtotalAmt |
| Other Expenses Not Included | -$16,259 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | -$16,259 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $189,276,455 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2016. |
| Part XII, Line 2d: Other expenses and losses per audited F/S | Loss on Debt Refinancing $975349 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 300.000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4272 | PersonsServedCnt |
| Total Community Benefit Expns | $2,883,913 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,883,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 39428 | PersonsServedCnt |
| Total Community Benefit Expns | $29,314,404 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,389,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,925,263 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 43700 | PersonsServedCnt |
| Total Community Benefit Expns | $32,198,317 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,389,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,809,176 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09410 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $832 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $832 | NetCommunityBenefitExpnsAmt |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $46,980 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,980 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $47,812 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $47,812 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 43700 | PersonsServedCnt |
| Total Community Benefit Expns | $32,246,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,389,141 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,856,988 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09430 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,777,685 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $17,777 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $84,000,426 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $112,761,362 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$28,760,936 | MedicareSurplusOrShortfallAmt |
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WellSpan Good Samaritan Hospit | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4th Walnut Street | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.wellspan.org | WebsiteAddressTxt |
| State License | 072401 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Teaching Hospital | Yes (X) | TeachingHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.wellspan.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.wellspan.org | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (true) | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 300.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.0000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.wellspan.org | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.wellspan.org | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.wellspan.org | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 5 - Account Input from Persons Who Represent the Community | Prior to its affiliation with WellSpan Health, WellSpan-Good Samaritan Hospital conducted independent Community Health Needs Assessments (CHNA) of Lebanon County residents through key informant interviews and the collection and analysis of secondary data. In 2015, WellSpan-Good Samaritan Hospital engaged in the regional CHNA process conducted by WellSpan Health and its entities. Information collected through the CHNA was shared with key community stakeholders to gain their input and perspective on the data, to learn about the existing healthcare environment in Lebanon County, and to identify priorities on which three-year implementation strategies should focus. These stakeholders represented the Lebanon Family Health Services, Lebanon Valley Family YMCA, and the United Way of Lebanon County. A subsequent presentation and discussion of the data and identified priorities was held with the Community Health Council of Lebanon County, a coalition of diverse individuals and organizations working together to encourage and support a safe, healthy and substance-free community for every Lebanon County resident. Sectors represented in the Council included: aging population; behavioral health; community-based organizations; education; healthcare, specifically physical health, law enforcement, and; philanthropy. |
| Part V, Line 6a - List Other Hospital Facilities that Jointly Conducted Needs Assessment | Ephrata Community Hospital (Lancaster); Gettysburg Hospital (Adams), and; WellSpan Surgery and Rehabilitation Hospital and York Hospital (York) |
| Part V, Line 13b - Criteria For Providing Discounted Care If Not FPG | Patients 401% of poverty level and greater do not qualify for financial assistance. However, all uninsured patients qualify for a 20% "no insurance" discount, regardless of income. |
| Part V, Line 13h - Other Factors Used in Determing Amounts Charged Patients | WellSpan Health is committed to caring for all the members of its communities, regardless of their ability to pay. In recent years, overall charity care has decreased slightly as more people have obtained health insurance coverage through the Affordable Care Act and the expansion of Pennsylvanias Medical Assistance (Medicaid) program. WellSpan is proud to be a leading partner in the Healthy Community Network, which works to address the needs of uninsured and underinsured individuals in our community. In addition, the health system recently enhanced its financial assistance policy and the discounts that it provides on services. For example, if a patients income is less than 300 percent of the federal poverty level, that patient would be eligible for a 100 percent discount on the services provided. Additionally, significant discounts are available for patients whose income is between 300 percent and 400 percent of the federal poverty level. For more information on WellSpans Financial Assistance program, visit www.WellSpan.org/FinancialAssistance. |
| Part V, Line 16i - Other Means Hospital Facility Publicized the Policy | In an effort to make patients, families and others in our communities aware of the newly expanded Financial Assistance Policy, WellSpan broadly publicized its policy via promotional signage and the distribution of easy-to-read informational materials at registration sites throughout our communities. WellSpan provided information on the Financial Assistance Policy on its billing statements and included information in patient discharge materials. In addition, the materials and information are easily accessible via WellSpans website at www.WellSpan.org/FinancialAssistance. The site reflects WellSpans newly enhanced policy, as well as informational and application materials. It was also publicized via WellSpans on-hold phone messaging system and in its direct-to-consumer community newsletter/magazine, which is distributed by mail, email and Web. In addition, WellSpan placed posters and signage at its various sites of care to publicize its Financial Assistance Policy. Printed copies of WellSpan Healths entire financial assistance policy and the plain language summary of the policy, both of which are available in English and Spanish, may be obtained at no cost by visiting or calling one of the WellSpan patient financial services offices. |
| Part V, Line 22d - Other Billing Determination of Individuals Without Insurance | WellSpan Health will provide assistance to all patients whose income falls within 400 percent of the federal poverty guidelines and within the asset limits listed on Attachment A. Those patients qualifying for financial assistance will receive a discount based on the amount generally billed (AGB), which is applicable to the facility at which services were provided. The AGB is calculated by the look-back method, in accordance with IRS Regulation 501(r). This is based on payment received from Medical Assistance and all private payors, in the most recent completed fiscal year. |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) | Patients 401% of poverty level and greater do not qualify for financial assistance. However, all uninsured patients qualify for a 20% "no insurance" discount, regardless of income. |
| Part I, Line 6a - Related Organization Community Benefit Report | Community Benefit Information is included in the Community Benefit Report for WellSpan Health. |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | The number was calculated using the cost to charge ratio factor applied against actual patient bad debt write-offs. These numbers are included after all efforts have been exhausted to determine if the patient meets our charity care write-off policy based on federal poverty levels. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | The estimate of bad debt attributable to charity care policy was calculated by dividing the bad debt amount that was originally coded bad debt but later found to qualify as charity care by the amount coded to the charity care write-off codes. This ratio is applied to the bad debt cost factor expense. |
| Part III, Line 4 - Bad Debt Expense | The Company provides an allowance for doubtful accounts for estimated losses resulting from the unwillingness or inability of patients to make payments for services. The allowance is determined by analyzing specific amounts and historical data and trends. Patient accounts receivable are charged off against the allowance for doubtful accounts when management determines that recovery is unlikely and the Company ceases collection efforts. Losses have been consistent with management's expectations in all material respects. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Good Samaritan Hospital maintains records to identify and monitor the level of charity care and community service it provides. These records include the amount of charges forgone based on established rates for services and supplies furnished under its charity care and community service policies and the estimated cost of those services. Payments from Medicare are generally less than Good Samaritan Hospital's costs of providing the service. |
| Part VI - Needs Assessment | After its affiliation with WellSpan Health, a regional health care system, WellSpan-Good Samaritan Hospital (WGSH) engaged in the next iteration of the system-wide CHNA process. This process, refined after being conducted in York and Adams counties for 20 years, enabled WGSH to collect primary data from Lebanon County residents, share it with key community, hospital and system leaders, and integrate it into the system-wide and entity-level planning processes. Through the consulting support of the Floyd Institute for Public Policy at Franklin and Marshall College. a representative sample of 896 Lebanon County adults were interviewed between February 23 and May 5, 2015 using survey questions derived from the Behavioral Risk Factor Surveillance System (BRFSS), a validated survey tool utilized by the Centers for Disease Control and Prevention (CDC), and organized into four categories: healthcare access, behavioral risk, health conditions, and prevention behaviors and context. Supplemental secondary data from the Robert Wood Johnson Foundation (RWJF) annual County Health Rankings and from the Pennsylvania Department of Health was compiled and integrated into the 2015 CHNA. Data collected and analyzed by the Floyd Institute for Public Policy included breakdowns by age, gender, geographic area, race/ethnicity, and income level, and enabled the development of charts/graphs focused on: quantity of residents affected; health risks and disability-adjusted life years; correlates of obesity and depression (two significant health priorities); health disparities, and; social determinants of health impact. This information is included in the 2015 Community Health Needs Assessment Summary Report available at www.wellspan.org. In 2015, CHNA results and related priorities identified by WellSpan-Good Samaritan Hospital and its community partners were shared with the system-wide Planning Committee at WellSpan Health. This Committee is comprised of community members and leaders that represent each of WellSpans primary entities and service areas, in addition to corporate leadership. Planning Committee members reviewed the CHNA data, adopted WGSHs community priorities of adult overweight/obesity, depression/mental health, and oral health/dental care while also identifying two additional priorities: access related to gaps in care caused by high-deductible insurance plans and the emerging opioid misuse and abuse issue facing the community. These priorities and associated data were subsequently presented to the WellSpan-Good Samaritan Hospital Board for their adoption. CHNA results were made available to the public on the WellSpan Health (www.wellspan.org) website, and may also be obtained upon request. |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | WellSpan-Good Samaritan Hospital continues to develop its suite of wellness and health education programs designed to address key CHNA findings and to promote healthy lifestyles and disease prevention. These programs include: community health screenings; healthy eating initiatives in the community (i.e., healthy cooking demonstrations at the Lebanon Farmers Market); weight management classes, and; physical activity promotion initiatives. Many of these programs are offered for free or at a minimal cost to the participant. One example of a unique community-based partnership that will be expanded offered by WellSpan-Good Samaritan Hospital is the Get Outdoors (GO) Lebanon! summer physical activity program. Originated in York County, this summer-long initiative encourages children and their families to be physically active by locating posts hidden in parks throughout York County. Results of the program are anticipated to be available in September 2016. WellSpan-Good Samaritan Hospital is an integral partner in the Community Health Council of Lebanon County and, as such, supports key Council initiatives such as the Lebanon County Tobacco Coalition, Lebanon County Teen Pregnancy and Support Network, and Lebanon County Suicide Task Force. In addition, the Good Samaritan Hospital Foundation assisted in raising financial support for the new Sechler Family Cancer Center. Additionally, WellSpan-Good Samaritan Hospital participated in system-wide initiatives to address the shared community health priorities of depression (mental health) and adult overweight/obesity. The Feeling Blue depression awareness campaign (www.feeling-blue.com) originated as a resource for York and Adams County adults suffering from mild depression. In 2016, Feeling Blue expanded to Lebanon County and continues to be a valuable resource for its community members. WellSpan-Good Samaritan Hospital also implemented the regional 10Lb. Throwdown initiative, a 10-week community challenge that encourages participants to lose or maintain a healthy weight through healthier eating and increased physical activity. The initiative was created to address the growing issue of adult overweight/obesity, and utilizes a core website (www.10poundthrowdown.com) on which may be found an online weight tracker, physical activity program (Make the Most of the Coast), and tips that promote a healthier lifestyle. More than 1900 community members across three southcentral Pennsylvania counties Adams, Lancaster, Lebanon, and York participated in the 2016 iteration of the 10Lb. Throwdown program. Additional examples of how WellSpan-Good Samaritan Hospital fulfilled its community mission in Lebanon County may be found in the 2016 WellSpan Community Benefit Report available online at www.wellspan.org. |
| Part VI - Affilated Health Care System Roles and Promotion | WellSpan Health is an integrated health system serving the communities of southcentral Pennsylvania and northern Maryland. As a community-based, not-for-profit organization, WellSpan is dedicated to improving the health and well-being of the people it serves. WellSpan will assume a leadership role and develop partnerships with other organizations to: improve access to coordinated, high-quality, cost-effective health care services, educate the health care providers of tomorrow, promote healthy lifestyles and lifelong wellness, and make its local communities healthier, more desirable places to live, work, and play. WellSpan Good Samaritan Community Hospital works with other parts of the system to provide a comprehensive approach to meeting community needs.WellSpan Health includes: WellSpan Gettysburg Hospital, WellSpan York Hospital, WellSpan Surgery and Rehabilitation Hospital, WellSpan Ephrata Community Hospital,WellSpan Good Samaritan Hospital, WellSpan Philhaven, Apple Hill Surgical Center, WellSpan VNA Home Health, WellSpan Medical Group, Northern Lancaster County Medical Group, Physician Specialists of Northern Lancaster County Medical Group, Good Samaritan Physician Services, WellSpan Population Health Services, WellSpan Pharmacy, Gettysburg Hospital Foundation, York Health Foundation, Ephrata Community Health Foundation, Good Samaritan Health Services Foundation, WellSpan Provider Network, GSH Services,and WellSpan Medical Equipment.Gettysburg Hospital's community benefit report is contained in a report prepared by their parent organization, WellSpan Health. See Attached Federal Supplemental Information: WellSpan Health - 2016 Community Benefit Report |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | United Way of Lebanon County | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 Cumberland St | AddressLine1Txt |
| City | Lebanon | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 231465632 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $7,975 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | Donation for 2015 Partnership | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Additional Supplemental Information | FormAndLineReferenceDesc |
| Explanation | All WellSpan non-research grant activities must be coordinated through the York Health Foundation, Good Samaritan Health Services Foundation, Ephrata Community Health Foundation and Gettysburg Hospital Foundation to insure that grant projects are implemented, evaluated, and monitored in accordance with applicable granting agency regulations, with WellSpan policies and procedures, and are consistent with the strategies and priorities of the organization. WellSpan has defined the processes by which grants are identified, developed, reviewed, approved, and monitored by the organization. This policy covers non-research grants applied for and received by an entity of WellSpan Health. It does not cover grants made by the organization. Research grants are defined as those that involve "a systematic investigation designed to develop or contribute to generalizable knowledge (45CFR 46.102(d))" and are overseen by Emig Research Center (Policy #619 Extramural Research Funding) | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Aaron Lane | |||||||||||||
| Physician | $162,360 | $25,128 | $19,979 | $207,467 | |||||||||
| Bryan Pilkington MD | |||||||||||||
| Trustee | $548,838 | $78,849 | $6,946 | $38,239 | $672,872 | ||||||||
| Byard Yoder | |||||||||||||
| Physician | $189,056 | $31,327 | $220,383 | ||||||||||
| Daria Kovarikova | |||||||||||||
| Physician | $196,757 | $9,984 | $30,294 | $237,035 | |||||||||
| Elizabeth Muhiire-Ntaki | |||||||||||||
| Physician | $164,207 | $8,646 | $33,102 | $205,955 | |||||||||
| Jacquelyn Gould | |||||||||||||
| VP of Nursing | $175,993 | $28,831 | $30,347 | $238,722 | $3,551 | ||||||||
| Jane Hyde | |||||||||||||
| Interim Pres. | $300,729 | $101,660 | $260,659 | $31,167 | $694,215 | $101,660 | |||||||
| Kevin Mosser | |||||||||||||
| CEO-WSH | $865,813 | $181,560 | $772,892 | $48,787 | $1,882,437 | $181,560 | $13,385 | ||||||
| Kimberly Feeman | |||||||||||||
| Senior VP & COO | $262,981 | $55,403 | $32,166 | $355,874 | $5,324 | ||||||||
| Kristen O'Shea | |||||||||||||
| Trustee | $270,867 | $52,994 | $22,737 | $39,739 | $391,841 | $5,504 | |||||||
| Michael O'Connor | |||||||||||||
| CFO-WSH | $543,913 | $155,040 | $440,496 | $47,841 | $1,187,290 | $155,040 | |||||||
| Randy Litman | |||||||||||||
| Physician | $248,074 | $20,284 | $269,596 | $1,238 | |||||||||
| Robert Longo | |||||||||||||
| Pres end 12/15 | $421,814 | $511,097 | $43,778 | $1,019,089 | $42,400 | ||||||||
| Robert Richards | |||||||||||||
| VP Finance & CFO | $252,405 | $52,224 | $29,163 | $385,619 | $3,719 | $48,108 | |||||||
| Robert Shaver | |||||||||||||
| VP of Medical Affairs | $304,812 | $49,949 | $32,738 | $387,499 | |||||||||
| William Mulligan | |||||||||||||
| VP-Strategic Planning | $138,847 | $22,576 | $31,883 | $196,197 | $2,891 | ||||||||
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | See Schedule O | BusinessNameLine1Txt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Reilly Wolfson Attorneys | |||
| Partner Wolfson | $329,292 | Attorney Fees | false |
| Funk Construction | |||
| President - Funk | $5,073,899 | Construction | false |
| Beers Hoffman Architech | |||
| Architect Hoffman | $167,906 | Architectural Serv | false |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Client Note 1 | Client Note 1 - 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) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | WellSpan Health, a not for profit corporation, is the sole member. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | The Board of Directors shall be elected by the Board of Directors of the Member. The Member shall determine annually the number of Directors which shall in no event be less than ten persons nor more than eighteen persons. In addition, the President of the Organization and the President of the Medical Staff of the Organization shall be Directors, ex officio, without vote.The Directors shall be elected at the annual meeting of the Member. The term of the newly elected Directors shall commence at the close of the Member's annual meeting. All Directors shall be selected for their experience, relevant areas of interest and expertise, and ability and willingness to participate actively and effectively in fulfilling the Board of Directors' responsibilities without conflicting interests. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | The Board of Directors shall recommend strategic and operating plans that are in conformance with System-approved priorities and plans; monitor accomplishment of such plans; recommend operating and capital budgets that are in conformance with System targets; monitor financial performance against budget; monitor the quality of and satisfaction with clinical services provided; serve as a sounding board for the Organization's President, providing advice and counsel to System and Organization management; nominate and, subject to the prior review and ratification of the Member, appoint the officers of the Organization, except for appointment of the Organizations' President, which requires the concurrence of both the Member and the Organization's Boards of Directors and whose removal by the Member requires prior consultation with the Organization's Board; maintain the licensure and accreditation of the Corporation, including, maintaining compliance with all of the applicable publicness requirements established by the Pennsylvania Department of Health for acute general hospitals, the Medicare Conditions of Participation established by CMS for hospitals, and the accreditation standards established by The Joint Commission for hospitals, including but not limited to requirements regarding medical staff appointments, credentialing, and oversight; recommend changes in the services provided by the Organization; recommend amendments to he Organization's Articles of Incorporation and/or Bylaws; recommend fundamental transactions involving the Organization, including the reorganization, merger, the sale of all or substantially all of the assets of the Organization, or dissolution of the Organization; recommend investment of the Organizations' assets other than in accordance with a WellSpan approved investment policy; recommend the issuance of debt for the Organization; recommend the transfer or sale of the Organizations' assets in excess of limits established by WellSpan policy; recommend capital expenditures by the Organization in excess of approved budget; recommend any capital contribution by the Member to the Corporation; recommend any material change to any permit, approval, or license of the Organization; recommend outside legal counsel for the Corporation's local needs or activities; recommend changes to the Organization's statement of mission and vision; recommend the creation of new (or material changes to existing) lines of business, sites of business, and participation in partnerships or joint ventures by the Organization; recommend changes to managed care and other third party payer contracts for the Organization; and represent the interests of the community or population served by the Organization. |
| 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 Chairman of the Board of Gettysburg Hospital shall participate. 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 Decreases | Change in Retirement Liability = -$5861596 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Increase in Restricted Assets = $1968 |
| Schedule K - Tax-Exempt Bonds | $412,230,0000 of Revenue Bonds for WellSpan Health Obligated Group, Series 2008A, 2008B, 2008C and 2008D were issued 11/12/2008 by General Authority of Southcentral Pennsylvania. The purpose of this bond issue was to refund bonds issued 5/13/2002, 5/17/2005, 6/16/2005, and 6/5/2007. 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 Specialty Services (23-2899911), and Good Samaritan Hospital (23-0794160). In order 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 6/30/16, the allocation of the Debt Capital program was as follows: York Hospital $159,515,555 (57.57%), WellSpan Properties $31,570,407 (11.39%), WellSpan Health $12,753,561 (4.60%), WellSpan Specialty Services $46,131,343 (16.65%), Gettysburg Hospital $24,900,141 (8.91%), and Good Samaritan Hospital $2,213,994 (.80%). These amounts are reported on the respective balance sheets (Part X Line 20)for each of these entities.The 11/12/2008 issue included reissuance of all unspent proceeds from the refunded 2007 bond issue. Total proceeds of issue includes the original 11/12/2008 issue plus investment earnings on transferred proceeds and the short investment of proceeds between date of issue and payoff on 12/1/2008.$213,430,000 of Revenue bonds for Wellspan Health Obligated Group, Series 2014A were issued November 11, 2014 by General Authority of South Central Pennsylvania. 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 Specialty Services (23-2899911), and Ephrata Community Hospital (23-1370484). In order 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 6/30/16, the allocation of the Debt Capital program including issue premium was as follows: York Hospital $139,356,809, Gettysburg Hospital $8,998,717, WellSpan Properties $34,893,001 and WellSpan Specialty Services $15,289,799. These amounts are reported on the respective balance sheets for each of these entities.On May 22, 2015, the Lancaster Municipal Authority issued $36,572,083 of Revenue 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. In order 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 6/30/16, the $35,133,947 of outstanding liability is reported on the Ephrata Community Hospital return balance sheet. |
| Signature Block - 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) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
| Part II Signature Block | 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) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (21 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Gettysburg Hospital | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 231352220 | Health Care Services | PA | 501(c)(3) | 3 | NA | false |
| Gettysburg Hospital Foundation | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232251358 | Fundraising to support GH | PA | 501(c)(3) | 11 Type 1 | NA | false |
| Healthy Community Pharmacy | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 200519121 | Reduced rate prescription drugs | PA | 501(c)(3) | 11 Type 1 | NA | false |
| VNA Community Services | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232338591 | Home Personal care services for elderly | PA | 501(c)(3) | 9 | NA | false |
| VNA Home Services | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 231352573 | Home health and hospice care services | PA | 501(c)(3) | 9 | NA | false |
| Wellspan Health | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 222517863 | Intergrated Health System | PA | 501(c)(3) | 11 Type 1 | NA | false |
| Wellspan Health Care Services | ||||||||||
| PO Box 2767 | York | PA | 174032767 | 232400237 | Health-related activities in the service | PA | 501(c)(3) | 11 Type 1 | NA | false |
| Wellspan Medical Group | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232730785 | Medical and Surgial care | PA | 501(c)(3) | 9 | NA | false |
| York Health Foundation | ||||||||||
| PO BOX 2767 | York | PA | 174052767 | 233050192 | Charitable contributions for Wellspan | PW | 501(c)(3) | 11 Type 3 | NA | false |
| York Hospital | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 231352222 | Community Teaching Hospital | PA | 501(c)(3) | 3 | NA | false |
| Wellspan Specialty Services | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232899911 | Mgmt. hospice/home health | PA | 501(c)(3) | 11 Type 1 | NA | false |
| Wellspan Properties Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 222842252 | Leases facilities to affiliates | PA | 501(c)(3) | 11 Type 1 | NA | false |
| Ephrata Community Hospital | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 231370484 | Health Care Services | 501(c)(3) | 3 | NA | false | |
| Ephrata Community Health Foundation | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 800940005 | Fundraising for Ephrata Hospital | PA | 501(c)(3) | 11 Type 1 | Ephrata Community Hospital | false |
| Northern Lancaster County Medical Group | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 203033058 | Medical and Surgical Care | PA | 501(c)(3) | 11 Type II | Ephrata community Hospital | false |
| Phys Spec of Northern Lanc Co Med Group | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 452537633 | Physician Practices | PA | 501(c)(3) | 11 Type II | Northern Lancaster County Med Group | false |
| Wellspan Philhaven | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 231549922 | Health Services | PA | 501(c)(3) | 3 | NA | false |
| Good Samaritan Health Service Foundation | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232356151 | Fundraising for Good Samaritan | PA | 501(c)(3) | 3 | NA | false |
| Good Samaritan Real Estate | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232447262 | Leases facilities to affiliates | PA | 501(c)(2) | NA | false | |
| Good Samaritan Physician Services | ||||||||||
| PO BOx 2767 | York | PA | 174052767 | 251832359 | Medical and Surgical Care | PA | 501(c)(3) | 9 | NA | false |
| Apple Hill Surgical Center Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 222842253 | Sole GP in limited ptnrshp operating sur | PA | 501(c)(3) | 9 | NA | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 | Ephrata Hospital | false | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|
| GSH Home Med Care Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 233028099 | Sales/rent of med equip & supplies | PA | GSH Services | C Corp | false | |
| GSH Services Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232353047 | Accounting and financial managment | PA | GS Health Foundation | C corp | false | |
| GSH Realty Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 251832359 | Rental of non res. real estate | PA | GSH Services | C corp | false | |
| Wellspan Pharmacy Inc | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232374072 | Dispense Rx & provides IV therapy | PA | C corp | false | N/A | |
| Wellspan Reciprocal Risk Retention Group | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 200048457 | Risk Retention Group | PA | NA | C corp | false | |
| York Health Plan | ||||||||||
| 2767 PO Box | York | PA | 174052767 | 232664989 | Preferred Provider Org | 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 | Homeowner Assoc | false | N/A | |
| Northern Lan Co Phys Hosp Alliance | ||||||||||
| PO Box 2767 | York | PA | 174052767 | 232421885 | Coord. Phys & Hospital | PA | NA | C corp | false | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | Yes (true) | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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