2017-05-10T07:47:16-07:00 2016-06-30 WELLSPAN HEALTH 3350 WHITEFORD ROAD YORK PA 17403 990 2015-07-01 230794160 GOOD SAMARITAN HOSPITAL GOOD 7178513055 PO BOX 2767 YORK PA 17405 Michael O'Connor CFO 2017-05-10 false DAVID P RIZZUTO P01210563 7178513095 2015 2021-01-29 14:40:06Z X Kevin Mosser MD 182262322 false false X WWW.WELLSPAN.ORG X 1989 PA The Good Samaritan Hospital is a tax-exempt organization dedicated to providing high-quality, compassionate healthcare that improves the overall health of the community. 20 14 1570 290 3647928 563601 2091000 474723 181425802 176258293 681500 3499891 4227737 2029415 188426039 182262322 13900 7975 0 75332328 84696439 0 575766 108604723 104572041 183950951 189276455 4475088 -7014133 137841236 115305046 148071758 142740374 -10230522 -27435328 The Good Samaritan Hospital is a tax-exempt organization dedicated to providing high-quality, compassionate healthcare that improves the overall health of the community. false false 146821589 7975 177440483 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 146821589 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false true false false false false false true false false false false true 111 0 true 1570 true true true false false false false false false 0 false false false false false false false false false false X 20 14 false false false false true true true true true false false true true true true true true true true true true PA X DAVID P RIZZUTO 7178513055 3350 WHITEFORD ROAD YORK PA 174029081 X Robert Longo Pres end 12/15 40.00 0.00 X X 932911 0 86178 Jane Juppenlatz Secr. end 7/15 1.00 0.00 X X 0 0 0 Thomas Harlow Pres Beg 06/16 1.00 0.00 X X 0 0 0 Jane Hyde Interim Pres. 1.00 40.00 X X 0 402389 291826 Kevin Mosser CEO-WSH 1.00 40.00 X X 0 1060758 821679 Dennis Shalters Trustee 1.00 0.00 X 0 0 0 Evelyn Colon Trustee 1.00 0.00 X 0 0 0 Paul DiGiacomo MD Trustee 1.00 0.00 X 0 0 0 Donald Dreibelbis Trustee 1.00 0.00 X 0 0 0 Robert Funk Trustee 1.00 0.00 X 0 0 0 Robert Hoffman Trustee 1.00 0.00 X 0 0 0 Frederick Laurenzo Trustee 1.00 0.00 X 0 0 0 Robert Phillips Trustee 1.00 0.00 X 0 0 0 Galen Weaber Trustee 1.00 0.00 X 0 0 0 Bryan Pilkington MD Trustee 1.00 40.00 X 0 627687 45185 Carol Blecker Trustee 1.00 0.00 X 0 0 0 William Schaeffer Jr MD Trustee 1.00 0.00 X 0 0 0 Deborah Weaver Trustee 1.00 0.00 X 0 0 0 Julie Zinsser Trustee 1.00 0.00 X 0 0 0 Kristen O'Shea Trustee 1.00 40.00 X 0 329365 62476 John Welch MD Trustee 1.00 0.00 X 0 0 0 Frederick Wolfson Trustee 1.00 0.00 X 0 0 0 Michael O'Connor CFO-WSH 1.00 40.00 X 0 698953 488337 Jacquelyn Gould VP of Nursing 40.00 0.00 X 204824 0 33898 Robert Shaver VP of Medical Affairs 40.00 0.00 X 354761 0 32738 William Mulligan VP-Strategic Planning 40.00 0.00 X 161423 0 34774 Kimberly Feeman Senior VP & COO 40.00 0.00 X 318384 0 37490 Robert Richards VP Finance & CFO 40.00 0.00 X 352737 0 32882 Randy Litman Physician 40.00 0.00 X 248074 0 21522 Daria Kovarikova Physician 40.00 0.00 X 206741 0 30294 Byard Yoder Physician 40.00 0.00 X 189056 0 31327 Aaron Lane Physician 40.00 0.00 X 187488 0 19979 Elizabeth Muhiire-Ntaki Physician 40.00 0.00 X 172853 0 33102 3329252 3119152 2103687 53 false true false Lebanon Anesthesia Assoc LTD 110 29th Avenue North Suite 301 Nashville TN 37203 Anes svcs, Qual Metr 3643068 Lebanon Cardiology Associates 775 Norman Drive Lebanon PA 17042 Cardiac admin,qual m 2181033 American Healthcare Services Association PO Box 945 Traverse City MI 49685 Healthcare staffing, 1406927 Diversified Clinical Services PO Box 636981 Cincinnati OH 452636981 Wound Care Ctr Mgmt 818195 Womens Health Center of Leb Ltd 300 Willow Street Lebanon PA 17046 Call coverage, resid 565556 24 449493 18336 6894 474723 EHR Incentive Program(MU) 621500 978208 978208 Net Patient Services 621500 191466188 187818260 3647928 W/O- Financial Assistance 621500 -10013586 -10013586 W/O-Bad Debt 621500 -6172517 -6172517 176258293 4460454 4460454 -975349 -975349 0 279097 279097 279097 279097 14786 14786 14786 14786 0 0 0 Cafeteria Sales 722210 678357 678357 Management Services 900099 568128 568128 Other Operating Revenue 900099 238511 238511 265322 265322 1750318 182262322 172817206 3647928 5322465 7975 7975 0 0 0 2540600 2540600 0 62472150 50691330 11780820 5649579 4478872 1170707 9005296 5698490 3306806 5028814 4073042 955772 0 212823 212823 420884 420884 8928 8928 0 0 7427283 6149440 702077 575766 1410677 8 1410669 1381316 974258 407058 0 0 1575366 1303359 272007 107378 70599 36779 0 147327 127622 19705 2614064 2614064 0 6168691 4649851 1518840 3042701 3042701 Purchased Services 36161624 23535668 12625956 Medical Supplies 31400035 31400035 Repairs & Maintenance 6321931 2454337 3867594 Equipment Rentals 3471905 3471905 2699108 2078033 621075 189276455 146821589 41879100 575766 5926 6276 2016900 4288749 5082853 2624001 21847380 24831214 0 0 540242 0 1404122 1903412 3094902 2125505 210657430 146332030 58404475 64325400 35226593 7179049 26124 0 102000 10217843 7893316 137841236 115305046 28482428 14940790 5578495 60794000 2431225 6113784 62917118 52681546 56872746 148071758 142740374 X -17101000 -34547468 6182000 6395223 688478 716917 -10230522 -27435328 137841236 115305046 X -7014133 -4331045 -5859628 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false true 8928 8928 false false Part II-B, Line 1i - Other Activities Description 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. 6868452 289830 21394 67536 7112140 7412227 989598 19671 1553044 6868452 4073656 3551208 40947 253584 7412227 2719409 2252267 54351 952371 4073656 2945233 424618 53135 703577 2719409 0.10080 0.89920 false false false 1468847 1468847 69745933 27557060 42188873 34178253 28356314 5821939 104312141 90418656 13893485 952256 952256 64325400 Private Equity, Ltd Partners 646 F Real estate, limited partnerships 1441 F Absolute return, Ltd Ptnrs 1465 F Collective mutual funds & inv trusts 17724 F Short Term Investments 3672 F Accounts Receivable - Affiliates Beneficial Interest Trust 228588 7893316 Accrued Payroll 3396129 Accrued Payroll w/h 603667 Accrued Pension 44911350 Accrued Sales Tax 14273 Accrued Vacation 4276979 Due to Affiliates 1039857 Insurance Reserve 1198951 Post Retirement Benefit Obligations 1431540 56872746 X 178683905 -4347731 -4347731 183031636 -769314 -769314 182262322 190268063 975349 975349 189292714 -16259 -16259 189276455 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 true true X true X 300.000000000 true X true true false false true true 4272 2883913 2883913 0.01520 39428 29314404 14389141 14925263 0.07890 43700 32198317 14389141 17809176 0.09410 1 832 832 1 46980 46980 0.00020 2 47812 47812 0.00020 2 43700 32246129 14389141 17856988 0.09430 true 1777685 17777 84000426 112761362 -28760936 true true 1 1 WellSpan Good Samaritan Hospit 4th Walnut Street Lebanon PA 17042 http://www.wellspan.org 072401 X X X X false false true X X X X X X X X 15 true true true true X www.wellspan.org X true 15 true www.wellspan.org true false true X 300.0000 400.0000 X X X X X X X true true X X X X true X www.wellspan.org X www.wellspan.org X www.wellspan.org X X X X X true X false X X X X true X false false 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. 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 true United Way of Lebanon County 801 Cumberland St Lebanon PA 17042 231465632 501(c)(3) 7975 0 Donation for 2015 Partnership 1 0 Additional Supplemental Information 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) X X X X X false true false false false false false false false false Aaron Lane Physician 162360 25128 19979 207467 Bryan Pilkington MD Trustee 548838 78849 6946 38239 672872 Byard Yoder Physician 189056 31327 220383 Daria Kovarikova Physician 196757 9984 30294 237035 Elizabeth Muhiire-Ntaki Physician 164207 8646 33102 205955 Jacquelyn Gould VP of Nursing 175993 28831 3551 30347 238722 Jane Hyde Interim Pres. 300729 101660 260659 31167 694215 101660 Kevin Mosser CEO-WSH 865813 181560 13385 772892 48787 1882437 181560 Kimberly Feeman Senior VP & COO 262981 55403 5324 32166 355874 Kristen O'Shea Trustee 270867 52994 5504 22737 39739 391841 Michael O'Connor CFO-WSH 543913 155040 440496 47841 1187290 155040 Randy Litman Physician 248074 1238 20284 269596 Robert Longo Pres end 12/15 421814 511097 42400 43778 1019089 Robert Richards VP Finance & CFO 252405 52224 48108 3719 29163 385619 Robert Shaver VP of Medical Affairs 304812 49949 32738 387499 William Mulligan VP-Strategic Planning 138847 22576 2891 31883 196197 A See Schedule O Reilly Wolfson Attorneys Partner Wolfson 329292 Attorney Fees false Funk Construction President - Funk 5073899 Construction false Beers Hoffman Architech Architect Hoffman 167906 Architectural Serv false 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 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 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 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 N/A C corp false 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 N/A Homeowner Assoc false Northern Lan Co Phys Hosp Alliance PO Box 2767 York PA 174052767 232421885 Coord. Phys & Hospital PA NA C corp false false false true false true false false true false false true false true false false true false true false