GREEN HOME: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- GREEN HOME (EIN 24-0804365)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-02
- IRS object ID
- 201741229349301209
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-02T12:49:30-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E St Louis Street Suite 200 | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 65806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 240804365 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Green Home | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GREE | BusinessNameControlTxt |
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 32-36 Central Ave | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Eric D Pohjala | PersonNm |
| Person Title | Executive Vice President/CFO | PersonTitleTxt |
| Phone | 5703213175 | PhoneNum |
| Signature | 2017-05-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Brian D Todd | PreparerPersonNm |
| PTIN | P00422601 | PTIN |
| Phone | 4178658701 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 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 | Steven P Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 High Street | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $10,775,774 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.susquehannahealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1974 | FormationYr |
| Legal Domicile State | PA | LegalDomicileStateCd |
| Activity Or Mission | The Green Home is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world class health system. Our values are putting patients first, sharing ownership and being servant leaders. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 150 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,255 | PYContributionsGrantsAmt |
| CY Contributions Grants | $660 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $10,855,937 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,760,546 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,129 | PYInvestmentIncomeAmt |
| CY Investment Income | $13,021 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,070 | PYOtherRevenueAmt |
| CY Other Revenue | $1,547 | CYOtherRevenueAmt |
| PY Total Revenue | $10,870,391 | PYTotalRevenueAmt |
| CY Total Revenue | $10,775,774 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,613,170 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,642,272 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,804,000 | PYOtherExpensesAmt |
| CY Other Expenses | $5,152,155 | CYOtherExpensesAmt |
| PY Total Expenses | $11,417,170 | PYTotalExpensesAmt |
| CY Total Expenses | $11,794,427 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$546,779 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,018,653 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $9,721,822 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,020,382 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,100,455 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,288,534 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,621,367 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,731,848 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The Green Home is a subsidiary of UPMC Susquehanna. The mission of UPMC Susquehanna and affiliates is as follows: To extend God's healing love by improving the health of those we serve. Our vision is to create a world class health system. Our values are putting patients first, sharing ownership and being servant | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,127,786 | ExpenseAmt |
| Revenue | $9,940,870 | RevenueAmt |
| Desc | The Green Home operated a 120-bed skilled nursing facility that provided both long-term care and short-term services for residents. Services provided include round-the-clock professional nursing; physical, occupational, and speech rehabilitation services; medical social work and counseling services; nutrition services; podiatry services; radiology services; dentistry; and a variety of activities and recreational programs.The average daily census was 101. The payor mix was 75% Medicaid, 10% Medicare and 15% self-pay residents. Rehabilitation services provided included 14,674 physical therapy treatments, 15,565 occupational therapy treatments and 4,669 speech therapy treatments. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $705,783 | ExpenseAmt |
| Revenue | $821,223 | RevenueAmt |
| Desc | The Green Home operated The Laurels, a 30 unit personal care home serving individuals aged 62 and older. The Laurels had an occupancy rate of 82% with 100% self pay residents. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $10,833,569 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 150 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | PA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Management | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5707230605 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 Meade St Ste U-6 | AddressLine1Txt |
| City | Wellsboro | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 16901 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Jill A Burns | ||||||||||
| Director | 0.33 | 45.67 | Yes (X) | $0 | $296,503 | $37,541 | ||||
| James D Baker Jr | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Lisa V Feil PsyD | ||||||||||
| Director | 0.33 | 3.67 | Yes (X) | $0 | $0 | $0 | ||||
| Robert P Fitzgerald | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Harold F Hoose II | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Steven P Johnson | ||||||||||
| CEO | 0.33 | 53.67 | Yes (X) | $0 | $832,199 | $35,182 | Yes (X) | |||
| Walter J Laibinis DO | ||||||||||
| Director | 0.33 | 43.67 | Yes (X) | $0 | $293,550 | $33,435 | ||||
| Michael W Lichty | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Craig G Litchfield | ||||||||||
| Treasurer (ending 6/15) | 0.33 | 3.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| J Dennis Murray | ||||||||||
| Director | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | ||||
| Thomas M Owlett Esq | ||||||||||
| Chairman | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Glenn B Poirer | ||||||||||
| Vice Chairman | 0.33 | 7.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Wendy S Swartz CPA | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Aneurin J Williams Jr | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Donna R Wilson | ||||||||||
| Director | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | ||||
| Kathy J Wright PhD | ||||||||||
| Secretary | 0.33 | 1.67 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| Janie M Hilfiger | ||||||||||
| President SSMH | 0.33 | 41.67 | $0 | $180,881 | $17,488 | Yes (X) | ||||
| Eric D Pohjala | ||||||||||
| Exec VP/CFO | 1.00 | 42.00 | $0 | $255,157 | $27,349 | Yes (X) | ||||
| Jan E Fisher | ||||||||||
| Exec VP/COO | 1.00 | 42.00 | $0 | $459,806 | $31,992 | Yes (X) | ||||
| David Lopatofsky MD | ||||||||||
| Exec VP/CMO | 1.00 | 42.00 | $0 | $437,276 | $38,887 | Yes (X) | ||||
| Cindy Frost | ||||||||||
| Nursing Home Administrator | 40.00 | $119,176 | $0 | $18,163 | Yes (X) | |||||
| Jacqueline B Werts | ||||||||||
| Director Nursing Home Admin/TGH | 40.00 | $109,271 | $0 | $5,963 | Yes (X) | |||||
| Paula Davis | ||||||||||
| Supvisor Asst DON/TGH | 40.00 | $104,896 | $0 | $17,808 | Yes (X) | |||||
| Daisy Bova | ||||||||||
| Supvisor RN/Hospital/LTC | 40.00 | $103,623 | $0 | $15,087 | Yes (X) | |||||
| Charles Santangelo | ||||||||||
| Former Exec VP/CFO (retired) | 0.00 | $0 | $338,073 | $24,988 | Yes (X) | |||||
| William McCauley MD | ||||||||||
| Former Exec VP/CMO (retired) | 0.00 | $0 | $185,372 | $4,271 | Yes (X) | |||||
| Ronald J Bulter | ||||||||||
| Former Exec VP/CBO (retired) | 0.00 | 2.00 | $0 | $518,626 | $13,502 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $436,966 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,797,443 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $321,656 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Genesis Eldercare Rehab | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 East State St | AddressLine1Txt |
| City | Kennett Square | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19348 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Rehabilitation Services | ServicesDesc |
| Compensation | $834,176 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $660 | AllOtherContributionsAmt |
| Total Contributions | $660 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Skilled Nursing Care | 623000 | $9,926,539 | $9,926,539 |
| Personal Care Home | 623000 | $821,223 | $821,223 |
| Employee & Guest Meals | 722210 | $6,987 | $6,987 |
| Beauty Shop | 812900 | $5,797 | $5,797 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,760,546 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,021 | TotalRevenueColumnAmt |
| Exclusion | $13,021 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $1,547 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,547 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,547 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,775,774 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,762,093 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,021 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,983,452 | TotalAmt |
| Program Services | $4,742,753 | ProgramServicesAmt |
| Management And General | $240,699 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $265,324 | TotalAmt |
| Program Services | $249,155 | ProgramServicesAmt |
| Management And General | $16,169 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,034,003 | TotalAmt |
| Program Services | $1,031,940 | ProgramServicesAmt |
| Management And General | $2,063 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,493 | TotalAmt |
| Program Services | $338,233 | ProgramServicesAmt |
| Management And General | $21,260 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,885 | TotalAmt |
| Program Services | $25,278 | ProgramServicesAmt |
| Management And General | $350,607 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,495 | TotalAmt |
| Management And General | $8,495 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,229,480 | TotalAmt |
| Program Services | $2,229,480 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,369 | TotalAmt |
| Program Services | $28,050 | ProgramServicesAmt |
| Management And General | $11,319 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,045 | TotalAmt |
| Program Services | $679 | ProgramServicesAmt |
| Management And General | $1,366 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,706 | TotalAmt |
| Program Services | $402,311 | ProgramServicesAmt |
| Management And General | $18,395 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,098 | TotalAmt |
| Program Services | $3,150 | ProgramServicesAmt |
| Management And General | $948 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,378 | TotalAmt |
| Program Services | $10,378 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $312,493 | TotalAmt |
| Program Services | $312,493 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,692 | TotalAmt |
| Program Services | $139,692 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Resident Care Supplies | $1,591,540 | $1,302,798 | $288,742 |
| Bad Debt | $17,000 | $17,000 | |
| Dues | $974 | $179 | $795 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,794,427 | TotalAmt |
| Program Services | $10,833,569 | ProgramServicesAmt |
| Management And General | $960,858 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250 | BOYAmt |
| EOY | $1,250 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,099,032 | BOYAmt |
| EOY | $985,536 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,592,070 | BOYAmt |
| EOY | $1,549,966 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,499,524 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $11,518 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,089 | BOYAmt |
| EOY | $9,900 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,501,030 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,082,842 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,521,857 | BOYAmt |
| EOY | $3,418,188 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $14,044,024 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,721,822 | BOYAmt |
| EOY | $20,020,382 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,351,472 | BOYAmt |
| EOY | $1,387,942 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,887 | BOYAmt |
| EOY | $160,842 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,604 | BOYAmt |
| EOY | $89,529 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,510,492 | BOYAmt |
| EOY | $15,650,221 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,100,455 | BOYAmt |
| EOY | $17,288,534 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,621,367 | BOYAmt |
| EOY | $2,731,848 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,621,367 | BOYAmt |
| EOY | $2,731,848 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,721,822 | BOYAmt |
| EOY | $20,020,382 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,018,653 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $129,134 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $6,623 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,225 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,840 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,255 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $660 | CurrentTaxYearAmt |
| Total | $12,603 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,441,744 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,866,886 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,538,292 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,857,087 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,731,412 | CurrentTaxYearAmt |
| Total | $52,435,421 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,448,367 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,868,111 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,541,132 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,858,342 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,732,072 | CurrentTaxYearAmt |
| Total | $52,448,024 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $52,448,024 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -$1,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $114,578 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,049 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,021 | CurrentTaxYearAmt |
| Total | $163,004 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | -$1,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $114,578 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,049 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,021 | CurrentTaxYearAmt |
| Total | $163,004 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,446,608 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,982,689 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,566,247 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,870,391 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,745,093 | CurrentTaxYearAmt |
| Total | $52,611,028 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99690 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99310 | PublicSupportPY509Pct |
| Investment Income CY | 0.00310 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00690 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $305,800 | BeginningYearBalanceAmt |
| Contributions | -$335,097 | ContributionsAmt |
| Investment Earnings Or Losses | $29,815 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $518 | AdministrativeExpensesAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $272,788 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $34,234 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,222 | AdministrativeExpensesAmt |
| End Year Balance | $305,800 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $278,971 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$5,086 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $1,097 | AdministrativeExpensesAmt |
| End Year Balance | $272,788 | EndYearBalanceAmt |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $318,358 | OtherCostOrOtherBasisAmt |
| Book Value | $318,358 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,622,208 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,542,957 | DepreciationAmt |
| Book Value | $2,079,251 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,283,413 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,339,151 | DepreciationAmt |
| Book Value | $944,262 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $277,051 | OtherCostOrOtherBasisAmt |
| Depreciation | $200,734 | DepreciationAmt |
| Book Value | $76,317 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,418,188 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due to/from affiliates | $13,999,710 |
| Due to/from 3rd parties | $44,314 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,044,024 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Affiliates | Desc |
| Amt | $15,650,221 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $15,650,221 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $10,758,774 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$17,000 | OtherRevenueAmt |
| Revenue Not Reported | -$17,000 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,775,774 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,775,774 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,777,427 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,777,427 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $17,000 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $17,000 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,794,427 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | Security deposits and personal care account funds |
| Part V, Line 4: | The endowment funds are used to fund the mission of the organization. |
| Part XI, Line 2d - Other Adjustments: | Bad Debt - (17,000) |
| Part XII, Line 4b - Other Adjustments: | Bad Debt - 17,000 |
| Part X Line 2 | The System companies, with the exception of SVI, CB, SHSIN, TMSO and TCN, have been recognized as exempt from imcome taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However these entites are subject to federal income tax on any unrelated business taxable income. SVI, CB, SHSIN, TMSO and TCN account for income in accordance with income tax accounting guidance (ASC 740 Income Taxes). |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jill A Burns | ||||||||||||||
| Director | $0 | $247,243 | $0 | $44,446 | $0 | $4,814 | $0 | $9,950 | $0 | $27,591 | $0 | $334,044 | $0 | $0 |
| Steven P Johnson | ||||||||||||||
| CEO | $0 | $668,195 | $0 | $133,858 | $0 | $30,146 | $0 | $15,925 | $0 | $19,257 | $0 | $867,381 | $0 | $0 |
| Walter J Laibinis DO | ||||||||||||||
| Director | $0 | $231,118 | $0 | $45,655 | $0 | $16,777 | $0 | $9,950 | $0 | $23,485 | $0 | $326,985 | $0 | $0 |
| Janie M Hilfiger | ||||||||||||||
| President SSMH | $0 | $163,729 | $0 | $14,229 | $0 | $2,923 | $0 | $7,416 | $0 | $10,072 | $0 | $198,369 | $0 | $0 |
| Eric D Pohjala | ||||||||||||||
| Exec VP/CFO | $0 | $252,402 | $0 | $0 | $0 | $2,755 | $0 | $9,720 | $0 | $17,629 | $0 | $282,506 | $0 | $0 |
| Jan E Fisher | ||||||||||||||
| Exec VP/COO | $0 | $409,956 | $0 | $36,987 | $0 | $12,863 | $0 | $9,950 | $0 | $22,042 | $0 | $491,798 | $0 | $0 |
| David Lopatofsky MD | ||||||||||||||
| Exec VP/CMO | $0 | $412,757 | $0 | $18,458 | $0 | $6,061 | $0 | $11,275 | $0 | $27,612 | $0 | $476,163 | $0 | $0 |
| Charles Santangelo | ||||||||||||||
| Former Exec VP/CFO (retired) | $0 | $186,916 | $0 | $71,895 | $0 | $79,262 | $0 | $9,950 | $0 | $15,038 | $0 | $363,061 | $0 | $0 |
| William McCauley MD | ||||||||||||||
| Former Exec VP/CMO (retired) | $0 | $108,272 | $0 | $45,384 | $0 | $31,716 | $0 | $0 | $0 | $4,271 | $0 | $189,643 | $0 | $0 |
| Ronald J Bulter | ||||||||||||||
| Former Exec VP/CBO (retired) | $0 | $112,293 | $0 | $32,105 | $0 | $374,228 | $0 | $9,950 | $0 | $3,552 | $0 | $532,128 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 Schedule J Part I Line 3 | The Williamsport Hospital EIN #24-0795508, a related organization, uses the following resources to establish the compensation of the top management officials: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board. |
| Form 990 Schedule J Part I Line 6 | In order for the Leadership Team to participate in the annual Variable Compensation Incentive Program (VCIP) a minimum operating margin must be achieved for the most recently completed year on a consolidated system-level basis. Individual goals and objectives related to the VCIP may also include individual entity operating performance. For FY 2016, the minimum threshold was met that would trigger VCIP payments. In December 2015, President/CEO Steven P. Johnson received a variable compensation award in the amount of $133,858. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 7a | UPMC Susquehanna, EIN 23-2751183, may elect or remove members of the governing body. |
| Form 990, Part VI, Section A, line 7b | All the business and affairs of the Entity shall be managed and controlled by the Board of Directors, subject to the oversight of the sole Member, UPMC Susquehanna, of the management and operation of the Entity, except that the following powers are reserved exclusively to the sole Member of the Entity, and no attempted exercise of any such powers by anyone other than the sole Member shall be valid of any force or effect whatsoever. The sole Member shall exercise its powers through its Board of Directors. The sole Member shall have the exclusive authority to exercise the following powers: A) to appoint or elect the directors B) to appoint and remove the President following consultation with the Entity C) to approve the nominees for elected officers and to return the list of approved nominees to the governing bodies for election D) to remove, with or without cause, any director or any elected officer E) to amend the Governing Instruments and to approve all amendments to the Governing Instruments which are proposed for adoption F) to approve the annual operating and capital budgets G) to establish requirements for unified budget H) to approve the incurrence or issuance of debt proposed by Entity and the encumbrance of any Entity assets to secure any such incurred debt I) to incur debt (or to cause debt to be incurred) on behalf of the Entity J) to require contributions in cash or cash equivalents to support the working capital needs or capital projects of any one or more System Entities K) to require that any debt incurred on a System wide basis by or at the direction of SHS shall be the joint and several obligation of each System Entity L) to direct or approve any cash contributions or any other capital contributions made by one System Entity to another System Entity M) to allocate any financial resources in such manner as SHS determines to be necessary N) to approve the sale, transfer or other disposition of Entity or Entity property unless it is made in the ordinary course of business or involves assets with a fair market value of less than one hundred dollars O) to direct the transfer of property from the Entity to one or more other System Entities P) to approve of any investment of assets by Entity not within the limits of the System's approved investment policy Q) to establish requirements for the approval of the acquisition, purchase, sale, transfer, encumbrance, leasing, construction or demolition of land or buildings outside the ordinary course of business R) to approve any decision with respect to the addition, modification or discontinuance of any patient care or diagnostic program or health care service Entity to add, modify, relocate or discontinue any patient care or diagnostic program or health care service U) to approve or direct any merger, consolidation, organization, reorganization, joint venture, corporate division, sale conversion, lease or exchange of substantially all the assets, dissolution, liquidation or any other modification of corporate structure or affiliations affecting the autonomy, governance, or operations, and the creation or acquisition of any new affiliate by Entity V) to dissolve or terminate the existence of Entity and to determine the distribution of assets upon such termination or dissolution W) to coordinate managed care plans involving Entit on behalf of Entity. |
| Form 990, Part VI, Section B, line 11 | A high-level overview of Forms 990 is presented to the parent Board of Directors (UPMC Susquehanna, #23-2751183) before filing and complete drafts of all returns are made available to all Board members through the CEO's and CFO's office. |
| Form 990, Part VI, Section B, line 12c | Annually on the 1st day of January, the UPMC Susquehanna CEO sends to all Directors, Officers, Management staff and contracted physicians a questionnaire to be completed and returned by January 15. A report is submitted to the Board of Directors to notify them of any conflicts of interest disclosed. |
| Form 990, Part VI, Section B, line 15 | On a bi-annual basis an independent compensation consulting firm performs an analysis of the Leadership salary structure in relationship to the labor market using data from four different salary surveys. Their analysis is reviewed with the Governance Committee of the Board of Directors. The firm then outlines its recommendations for the proposed executive salary structure to the Committee for their consideration and approval. |
| Form 990, Part VI, Section C, line 19 | Governing documents and financial statements are available to the public upon request. The conflict of interest policy is also available to the public. |
| Form 990, Part IX, line 11g | Other Purchased Services: Program service expenses 1709467. Management and general expenses 0. Fundraising expenses 0. Total expenses 1709467. Consulting: Program service expenses 1353. Management and general expenses 0. Fundraising expenses 0. Total expenses 1353. Inter-entity purchased services: Program service expenses 518660. Management and general expenses 0. Fundraising expenses 0. Total expenses 518660. |
| Form 990, Part XI, line 9: | Pension Liability Adjustment -220866. Transfer from affiliates 350000. |
| FORM 990, Part XII, Line 2c | The Organization Has changed neither the oversight process nor the independent accountant selection process during the fiscal year. |
| Form 990 | Effective October 1, 2016 the University of Pittsburgh Medical Center (UPMC) became the sole corporate member of Susquehanna Health System, EIN# 23-2751183 and the name was formally changed to UPMC Susquehanna. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laurel Health System | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 240795488 | Coordinate & Manage the delivery of healthcare | PA | 501 (c) (3) | 11 B II | UPMC Susquehanna | 0 | |
| Laurel Management Services | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251644910 | Management consulting and supervisory services | PA | 501 (c) (3) | 11 B II | UPMC Susquehanna | 0 | |
| Soldiers Sailors Memorial Hospital | |||||||||||
| 32-36 Central Ave | Wellsboro | PA | 16901 | 232176963 | Operate acute care hospital | PA | 501 (c) (3) | 3 | UPMC Susquehanna | 0 | |
| Tioga Health Care Providers | |||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 251765538 | Physician Services | PA | 501 (c) (3) | 11 B II | UPMC Susquehanna | 0 | |
| Laurel Realty | |||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 231403678 | Own and manage real estate in support of Laurel Health | PA | 501 (c) (2) | UPMC Susquehanna | 0 | ||
| Divine Providence Hospital | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 240799343 | Hospital | PA | 501 (c) (3) | 3 | UPMC Susquehanna | 0 | |
| Muncy Valley Hospital | |||||||||||
| 215 E Water St | Muncy | PA | 17756 | 240806023 | Hospital | PA | 501 (c) (3) | 3 | UPMC Susquehanna | 0 | |
| The Williamsport Hospital | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 240795508 | Hospital | PA | 501 (c) (3) | 3 | UPMC Susquehanna | 0 | |
| Susquehanna Health Foundation | |||||||||||
| 1100 Grampian Blvd | Williamsport | PA | 17701 | 232743470 | Fundraising for affiliated entities | PA | 501 (c) (3) | 11 A I | UPMC Susquehanna | 0 | |
| Susquehanna Physician Services | |||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232449454 | Physician services & MRI services | PA | 501 (c) (3) | 3 | UPMC Susquehanna | 0 | |
| Williamsport Area Ambulance Service Cooperative | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 232416166 | Ambulance transports | PA | 501 (c) (3) | 9 | 0 | N/A | |
| UPMC Susquehanna | |||||||||||
| 1205 Grampian Blvd | Williamsport | PA | 17701 | 232751183 | Coordinate and manage the delivery of healthcare | PA | 501 (c) (3) | 11 B II | 0 | N/A | |
| Laurel Health Foundation | |||||||||||
| 15 Meade St | Wellsboro | PA | 16901 | 251810488 | Fundraising for affiliated entities | PA | 501 (c) (3) | 11 A I | Laurel Health System | 0 | |
| North Penn Comprehensive Health Services | |||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 231889724 | Provides general health and social services | PA | 501 (c) (3) | 3 | 0 | N/A | |
| Susquehanna Health Innovation Center Inc | |||||||||||
| 700 High Street | Williamsport | PA | 17701 | 471600873 | Supporting organization of affiliated entities | PA | 501 (c) (3) | 11 A I | UPMC Susquehanna | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Basket LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1205 Grampian Blvd | AddressLine1Txt |
| City | Williamsport | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 17701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201195739 | EIN |
| Primary Activities | Rents real estate | PrimaryActivitiesTxt |
| Legal Domicile State | PA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPMC Susquehanna & Susquehanna Health Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | Excluded from tax | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 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 | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tyoga Carenet | |||||||||||||
| 22 Walnut St | Wellsboro | PA | 16901 | 251810967 | Integrate health care | PA | UPMC Susquehanna | C | 0 | ||||
| Susquehanna Ventures Inc | |||||||||||||
| 1201 Grampian Blvd | Williamsport | PA | 17701 | 232470263 | Pharmacy & Infusion services | PA | UPMC Susquehanna | C | 0 | ||||
| Susquehanna Health System Insurance Network LTD | |||||||||||||
| 980458722 | Captive Insurance Company | UPMC Susquehanna | 0 | PO Box 1159 | Grand Caymans | CJ | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form 990, Schedule R, Part IV | FormAndLineReferenceDesc |
| Explanation | Susquehanna Health System Insurance Network, LTD (SHSIN) EIN #98-0458722, is a foreign corporation, incorporated under the laws of the Cayman Islands. There are no income, capital, or premium taxes levied in the Cayman Islands and SHSIN had been granted an exemption until September 2022 for any such taxes that might be introduced. SHSIN's sole shareholder, UPMC Susquehanna EIN#23-2751183, is a 501(C)(3) organization exempt from federal income taxes. SHSIN conducts no business in the United States. It files an 1120F protective filing which implies that its income is not subject to US Federal income tax. | ExplanationTxt |