ROBERT PACKER HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ROBERT PACKER HOSPITAL (EIN 24-0795463)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201231359349303908
Schema version
2010v3.7
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

FieldValueIRS element (for citing)
Timestamp2012-05-14T13:25:16-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PricewaterhouseCoopers LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12001 MARKET ST SUITE 1700AddressLine1
CityPHILADELPHIACity
StatePAState
ZIP Code19103ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN240795463EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ROBERT PACKER HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlROBENameControl
Phone5708874625Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ONE GUTHRIE SQUAREAddressLine1
CitySAYRECity
StatePAState
ZIP Code18840ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARIE DROEGEName
TitlePRESIDENT & COOTitle
Date Signed2012-05-08DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone2673303000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARIE DROEGENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1GUTHRIE SQUAREAddressLine1
CitySAYRECity
StatePAState
ZIP Code18840ZIPCode
FieldValueIRS element (for citing)
Gross Receipts531720610GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GUTHRIE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1885YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionROBERT PACKER HOSPITAL PROVIDES HEALTHCARE SERVICES TO RESIDENTS OF THE SURROUNDING COMMUNITY ON AN IN-PATIENT AND OUT-PATIENT BASIS. APPROXIMATELY 14,628 PATIENTS WERE ADMITTED TO RPH IN FYE 6/30/11.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees1735TotalNbrEmployees
Total Nbr Volunteers194TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1824613ContributionsGrantsPriorYear
Contributions Grants Current Year2040853ContributionsGrantsCurrentYear
Program Service Revenue Prior Year240099269ProgramServiceRevenuePriorYear
Program Service Revenue CY263735137ProgramServiceRevenueCY
Investment Income Prior Year15375473InvestmentIncomePriorYear
Investment Income Current Year9769400InvestmentIncomeCurrentYear
Other Revenue Prior Year-2477988OtherRevenuePriorYear
Other Revenue Current Year4751467OtherRevenueCurrentYear
Total Revenue Prior Year254821367TotalRevenuePriorYear
Total Revenue Current Year280296857TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year15925GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY15600GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year74736374SalariesEtcPriorYear
Salaries Etc Current Year81752577SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year133967056OtherExpensePriorYear
Other Expenses Current Year148963309OtherExpensesCurrentYear
Total Expenses Prior Year208719355TotalExpensesPriorYear
Total Expenses Current Year230731486TotalExpensesCurrentYear
Revenues Less Expenses Prior Year46102012RevenuesLessExpensesPriorYear
Revenues Less Expenses CY49565371RevenuesLessExpensesCY
Total Assets BOY290767514TotalAssetsBOY
Total Assets EOY345324611TotalAssetsEOY
Total Liabilities BOY176817165TotalLiabilitiesBOY
Total Liabilities EOY159605290TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY113950349NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY185719321NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionROBERT PACKER HOSPITAL IS AN AFFILIATE OF GUTHRIE HEALTH. GUTHRIE HEALTH IS A NONPROFIT HEALTH CARE ORGANIZATION THAT SERVES TO COORDINATE THE ACTIVITY OF GUTHRIE CLINIC (CLINIC) AND THE AFFILIATES WITHIN GUTHRIE HEALTHCARE SYSTEM (GHS; SEE FORM 990, SCHEDULE R, FOR A LISTING OF AFFILIATES OF GHS, INCLUDING ROBERT PACKER HOSPITAL (RPH)). THROUGH THE ACTIVITIES OF THE CLINIC, GHS, RPH, AND ITS OTHER AFFILIATES (COLLECTIVELY REFERRED TO AS "GUTHRIE"), GUTHRIE HEALTH PROVIDES CHARITABLE COMMUNITY-BASED HEALTH CARE SERVICES AND PROGRAMS TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES SERVED BY ITS FACILITIES AND PROVIDERS. THESE CHARITABLE ACTIVITIES INCLUDE PROVIDING PRIMARY CARE AND SPECIALTY PHYSICIAN SERVICES, AS WELL AS OPERATING A TERTIARY CARE TEACHING HOSPITAL, COMMUNITY HOSPITALS, A RESEARCH INSTITUTE, HOME CARE, HOSPICE CARE AND A LONG-TERM CARE FACILITY. THE GUTHRIE RESEARCH INSTITUTE AND GUTHRIE CLINICAL RESEARCH FUNCTIONS OF THE GUTHRIE FOUNDATION FOR MEDICAMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense161433178Expense
Grants0Grants
Revenue263452599Revenue
DescriptionROBERT PACKER HOSPITAL PROVIDES HEALTHCARE SERVICES TO RESIDENTS OF THE SURROUNDING COMMUNITY ON AN IN-PATIENT AND OUT-PATIENT BASIS. APPROXIMATELY 14,628 PATIENTS WERE ADMITTED TO THE HOSPITAL IN FYE 6/30/2011. PATIENT DAYS TOTALED 64,721.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense9603835Expense
Grants15600Grants
Revenue282538Revenue
DescriptionROBERT PACKER HOSPITAL PROVIDES EDUCATION SERVICES TO ITS EMPLOYEES AND MEMBERS OF THE COMMUNITY. THE FOLLOWING EDUCATIONAL SERVICES ARE PROVIDED: 1) X-RAY TECHNOLOGY; 2) RESPIRATORY THERAPY; 3) MEDICAL RESIDENTS & STUDENTS; 4) LABORATORY TECHNOLOGY; AND 5) ROBERT PACKER SCHOOL OF NURSING (AN AFFILIATE).Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense171037013TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArttrueDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1735NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledPAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMICHELE Y SISTONamePerson
Telephone Number5708874625TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1ONE GUTHRIE SQUAREAddressLine1
CitySAYRECity
StatePAState
ZIP Code18840ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
MARIE DROEGE
PRESIDENT & COO40.0XX352282016268
DAVID LR GIBBS
CHAIRMAN BOD1.0X000
JOSEPH R JOYCE
SECRETARY/TREASURER BOD1.0X000
DANIEL J BROWN MD
MEMBER BOD1.0X045215243752
MARK A DIXON
MEMBER BOD1.0X000
MARVIN L FISHER II
MEMBER BOD1.0X000
KATHRYN B HASSEE
SECRETARY/TREASURER BOD1.0X000
DEAN HOSTERMAN
MEMBER BOD1.0X000
RHONDA G MOSS-TATICH
MEMBER BOD1.0X000
SURYA NARAYANAN MD
MEMBER BOD1.0X031926839612
SEAN NICHOLSON
MEMBER BOD1.0X000
BURDETT R PORTER MD
MEMBER BOD1.0X035859043752
DOUGLAS G RICH
MEMBER BOD1.0X000
DANIEL SPORN MD
MEMBER BOD1.0X056267043752
GAIL ORCHARD
MEMBER BOD1.0X000
MINH DANG
CFO39.0X021920931090
BONNIE ONOFRE
CHIEF NURSING OFFICER34.0197605014750X
GEORGE ELLIS MD
EMERGENCY MEDICINE CHAIRMAN40.0312161040939X
ANTHONY OLIVA DO CMO
CHIEF MEDICAL OFFICER32.0415814020301X
BARBARA PENNYPACKER
VP SURGICAL SERVICES27.0147329020870X
DAVID CHANNIN MD
CHAIR MEDICAL IMAGING40.0017482921243X
JOSEPH SAWYER
VP IMAGING & ANCILLARY TESTING26.0136909019236X
NATHAN SHINAGAWA
ADMINISTRATIVE DIRECTOR40.0698810320X
CHARLES MCGURK MD
PHYSICIAN40.0316182012901X
JAY SHAH MD
PHYSICIAN40.0278563024751X
RUSSETT BURKETT MD
PHYSICIAN40.0262300024751X
MARC HARRIS MD
PHYSICIAN40.0271429016268X
JAMES RAFTIS MD
PHYSICIAN40.0264900024751X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3025355TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2086718TotalReportableCompFrmRltdOrgs
Total Other Compensation459307TotalOtherCompensation
Number Individuals GT100 K35NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WELLIVER MCGUIRE INC
250 NORTH GENESEE STMONTOUR FALLSNY14865CONTRACTOR SERVICES2263950
GR NOTO ELECTRIC CONSTRUCTION
PO BOX 247CLARKS SUMMITPA18411CONTRACTOR SERVICES2233066
EXECUTIVE HEALTH RESOURCES
PO BOX 822688PHILADELPHIAPA19182HEALTH PROF SERVICES833329
NURSEFINDERS
PO BOX 910738DALLASTX75391HEALTHCARE SERVICES719773
DIVERSIFIED CLINICAL SERVICES
PO BOX 636981CINCINNATIOH37483HEALTHCARE SERVICES627953
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations18500RelatedOrganizations
Government Grants464104GovernmentGrants
All Other Contributions1558249AllOtherContributions
Noncash Contributions3456NoncashContributions
Total Contributions2040853TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE621990140228189140228189
EDUCATIONAL SERVICES611600282538282538
MEDICARE AND MEDICAID PAYMENTS621990123224410123224410
FieldValueIRS element (for citing)
Total Program Service Revenue263735137TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5597620TotalRevenueColumn
Exclusion$5,597,620ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities255539892Securities
Other55641Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities251011266Securities
Other412487Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4528626Securities
Other-356846Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4171780TotalRevenueColumn
Exclusion$4,171,780ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses0FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Gaming0GrossIncomeGaming
Gaming Direct Expenses0GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory0GrossSalesOfInventory
Cost Of Goods Sold0CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CHANGE IN DERIVATIVE INSTRUMENT900099-4212083-$4,212,083
GAIN ON RETIREMENT OF DEBT9000991172854$1,172,854
ALL OTHER REVENUE7790696$7,790,696
FieldValueIRS element (for citing)
Total Other Revenue4751467TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column280296857TotalRevenueColumn
Related Or Exempt Function Income263735137RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$14,520,867ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total15600Total
Program Services15600ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1764667Total
Program Services521300ProgramServices
Management And General1243367ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total62070358Total
Program Services52129415ProgramServices
Management And General9940943ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4067296Total
Program Services3357720ProgramServices
Management And General709576ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9128687Total
Program Services7128129ProgramServices
Management And General2000558ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4721569Total
Program Services3897841ProgramServices
Management And General823728ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total7301517Total
Program Services239952ProgramServices
Management And General7061565ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total528893Total
Program Services33683ProgramServices
Management And General495210ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total2053325Total
Management And General2053325ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total20189Total
Management And General20189ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total30585879Total
Program Services25616647ProgramServices
Management And General4969232ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total69531Total
Program Services67682ProgramServices
Management And General1849ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total61951809Total
Program Services56894834ProgramServices
Management And General5056975ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total5676289Total
Program Services928216ProgramServices
Management And General4748073ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4463525Total
Program Services474775ProgramServices
Management And General3988750ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total360958Total
Program Services328772ProgramServices
Management And General32186ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total208275Total
Program Services190150ProgramServices
Management And General18125ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2613757Total
Management And General2613757ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11629036Total
Program Services43962ProgramServices
Management And General11585074ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total2129450Total
Program Services797146ProgramServices
Management And General1332304ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT1775832617758326
CAFETERIA/CATERING363819262848100971
ACCRETION EXPENSES177913177913
ALL OTHER EXPENSES1070818350015720803

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total230731486Total
Program Services171037013ProgramServices
Management And General59694473ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2578326BOY
EOY6890030EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY781BOY
EOY522EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY27816844BOY
EOY29914564EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY90000BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5411981BOY
EOY5711862EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3498390BOY
EOY4045545EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis227836783LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec149166719LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY73370017BOY
EOY78670064EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY174570063BOY
EOY217413633EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3431112BOY
EOY2678391EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY290767514BOY
EOY345324611EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY32284215BOY
EOY33806818EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1683754BOY
EOY603027EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY142849196BOY
EOY125195445EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY176817165BOY
EOY159605290EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY110089583BOY
EOY182038126EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3812814BOY
EOY3631291EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY47952BOY
EOY49904EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY113950349BOY
EOY185719321EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY290767514BOY
EOY345324611EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses49565371ReconcilationRevenueExpenses
Reconcilation Other Changes22203601ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$20,189OtherActivitiesAmount
Total Lobbying Expenditures IIB20189TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE C, PART II-B, LINE 1JIdentifier
Return ReferenceOTHER LOBBYING ACTIVITIESReturnReference
ExplanationMEMBERSHIPS IN AMERICAN HOSPITAL (AHA) AND THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA (HAP)Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Included On FSfalseIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis877575OtherCostOrOtherBasis
Book Value877575BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis126379544OtherCostOrOtherBasis
Depreciation78871291Depreciation
Book Value47508253BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis4269109OtherCostOrOtherBasis
Depreciation1960800Depreciation
Book Value2308309BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis91811075OtherCostOrOtherBasis
Depreciation65812146Depreciation
Book Value25998929BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4499480OtherCostOrOtherBasis
Depreciation2522482Depreciation
Book Value1976998BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings78670064TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (7 entries)

DescriptionDescriptionAmountAmount
ESTIMATED THIRD PARTY PAYABLE$8,052,588
RPH AUXILARY INVESTMENTS$63,810
ASSET RETIREMENT OBLIGATION$3,727,472
SWAP CONTRACT PAYABLE 2007$356,850
SWAP CONTRACT PAY FMV 2007$14,658,022
DUE TO AFFILIATES$4,718,757
LOAN PAY-GH TAX EXEMPT BONDS$93,617,946
FieldValueIRS element (for citing)
Total Of Amounts125195445TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE D PART X LINE 2Identifier
ExplanationTHE CORPORATION HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION AND HAS CONCLUDED THAT AS OF JUNE 30, 2011, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1536799TotalCommunityBenefitExpense
Direct Offsetting Revenue243417DirectOffsettingRevenue
Net Community Benefit Expense1293382NetCommunityBenefitExpense
Percent Of Total Expense0.00560PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense22766185TotalCommunityBenefitExpense
Direct Offsetting Revenue18801412DirectOffsettingRevenue
Net Community Benefit Expense3964773NetCommunityBenefitExpense
Percent Of Total Expense0.01720PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense24302984TotalCommunityBenefitExpense
Direct Offsetting Revenue19044829DirectOffsettingRevenue
Net Community Benefit Expense5258155NetCommunityBenefitExpense
Percent Of Total Expense0.02280PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense733627TotalCommunityBenefitExpense
Direct Offsetting Revenue347001DirectOffsettingRevenue
Net Community Benefit Expense386626NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense8476753TotalCommunityBenefitExpense
Direct Offsetting Revenue3103138DirectOffsettingRevenue
Net Community Benefit Expense5373615NetCommunityBenefitExpense
Percent Of Total Expense0.02330PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense7359125TotalCommunityBenefitExpense
Direct Offsetting Revenue5504951DirectOffsettingRevenue
Net Community Benefit Expense1854174NetCommunityBenefitExpense
Percent Of Total Expense0.00800PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense16569505TotalCommunityBenefitExpense
Direct Offsetting Revenue8955090DirectOffsettingRevenue
Net Community Benefit Expense7614415NetCommunityBenefitExpense
Percent Of Total Expense0.03300PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense40872489TotalCommunityBenefitExpense
Direct Offsetting Revenue27999919DirectOffsettingRevenue
Net Community Benefit Expense12872570NetCommunityBenefitExpense
Percent Of Total Expense0.05580PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$5,403,859BadDebtExpenseAmount
Amount Reimbursed By Medicare85169968AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare72347335CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall12822633MedicareSurplusOrShortfall
Costing Methodology UsedCostingMethodologyUsed
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ROBERT PACKER HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1ONE GUTHRIE SQUAREAddressLine1
CitySAYRECity
StatePAState
ZIP Code18840ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ROBERT PACKER HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
ExplanationPART I, LINE 7A - COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET #2. PART I, LINE 7B - COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET #2. PART I, LINE 7E - THE COST METHODOLOGY USED WAS ACTUAL EXPENDITURES. PART I, LINE 7F- THE COST WAS TAKEN FROM THE MEDICARE COST REPORT. PART I, LINE 7G - A COST ACCOUNTING SYSTEM WAS USED. WITHIN THE COST ACCOUNTING SYSTEM, SOME PATIENT SEGMENTS WERE BASED ON A RATIO OF COST TO CHARGE - TOTAL DEPARTMENTAL EXPENSE PLUS ALLOCATED OVERHEAD SPREAD BASED ON CHARGES. PART III, LINE 4 - COST TO CHARGE WAS DERIVED FROM WORKSHEET #2. THIS WAS APPLIED TO GROSS BAD DEBT EXPENSE FROM THE FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE PART III, LINE 9B - ONCE A PATIENT IS APPROVED FOR CHARITY CARE OR AN INSTALLMENT PLAN, THEIR ACCOUNT IS TRANSFERRED TO EITHER THE BUDGET OR CHARITY CARE FINANCIAL CLASS. ACCOUNTS IN THESE FINANCIAL CLASSES ARE NOT PLACED WITH COLLECTION. PART VI, LINE 2 - THE ORGANIZATION HAS NOT DONE A HEALTH ASSESSMENT OF THE COMMUNITIES IT SERVES. THERE ARE PLANS TO COMPLETE AN ASSESSMENT DURING THE ORGANIZATION'S 2012 FISCAL YEAR. PART VI, LINE 3 - CHARITY CARE AVAILABILITY AND CONTACT INFORMATION ARE POSTED IN ALL REGISTRATION AREAS AND IN THE HOSPITAL'S BUSINESS OFFICE. THE CHARITY CARE POLICY, APPLICATION, AND CONTACT INFORMATION ARE POSTED ON THE HOSPITAL'S WEBSITE. SELF PAY PATIENTS ARE REFERRED TO THE HOSPITAL'S FINANCIAL COUNSELOR FROM PHYSICIAN OFFICES, SOCIAL WORKERS, OR SELF REFERRED. PART VI, LINE 3 - THE FINANCIAL COUNSELOR AS WELL AS THE BUSINESS OFFICE STAFF FOLLOW UP WITH SELF PAY PATIENTS TO ASSESS THEIR NEED AND ASSIST IN DETERMINING THEIR ELIGIBILITY FOR SECURING A PAYMENT SOURCE (I.E. COBRA COVERAGE, SPECIAL NEEDS PROGRAM, MEDICAID, OTHER FEDERAL/STATE PROGRAMS, OR CHARITY CARE). STAFF ALSO ASSIST WITH THE APPLICATION PROCESS AS REQUESTED BY SELF PAY PATIENTS. PART VI, LINE 3 - THE HOSPITAL'S BILLING STATEMENTS ALSO HAVE INFORMATION REGARDING WHOM TO CONTACT IN CASE A PATIENT NEEDS ASSISTANCE MEETING ITS FINANCIAL OBLIGATIONS. PART VI, LINE 4 - ROBERT PACKER HOSPITAL IS A 238-BED TERTIARY CARE TEACHING HOSPITAL LOCATED IN SAYRE, PA. THE HOSPITAL OFFERS A FULL COMPLEMENT OF MEDICAL AND SURGICAL SERVICES AS WELL AS SPECIALIZED PROGRAMS. THE HOSPITAL'S PRIMARY SERVICE LIES IN BRADFORD COUNTY IN PA AND STEUBEN AND TIOGA COUNTIES IN NEW YORK. THE SECONDARY SERVICE AREA INCLUDES CONTIGUOUS COUNTIES IN BOTH PA AND NY. PART VI, LINE 4 - THE POPULATION FOR THE TOTAL SERVICE AREA IS APPROXIMATELY 630,000 WITH 50% OF THE HOUSEHOLD INCOMES GENERALLY FALLING IN TWO CATEGORIES: $25,000 - $50,000 AND $50,000 - $75,000. PART VI, LINE 6 - SEE THE ATTACHED STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ATTACHED TO THE FORM 990 AS TO HOW THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUMNITY. PART VI, LINE 7 - SEE THE ATTACHED STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ATTACHED TO THE FORM 990.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantEducational Aid - Undergraduate StudentsTypeOfGrant
Number Of Recipients48NumberOfRecipients
Amount Of Cash Grant15600AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE I, PART I LINE 2 AND PART IIIIdentifier
Return ReferenceGRANTS TO INDIVIDUALS IN THE UNITED STATESReturnReference
ExplanationHealth Profession Scholarships - Seniors must plan to enter an accredited college, university, hospital based nursing, or allied health program with careers in health professions, including hospital administration or a planned career in medical research. Guthrie Employee Scholarships - These scholarships are offered to children of full-time employees of Guthrie. Seniors must plan to enter an accredited college or university. Any career interest is allowed.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MARIE DROEGE
29967805260400000162680368550000
DANIEL J BROWN MD
04388570132950000043752049590400
SURYA NARAYANAN MD
0319268000000039612035888000
BURDETT R PORTER MD
0358590000000043752040234200
DANIEL SPORN MD
0562670000000043752060642200
MINH DANG
01849930342160000031090025029900
BONNIE ONOFRE
17181002579500000147500212355000
GEORGE ELLIS MD
3024280973300000409390353100000
ANTHONY OLIVA DO CMO
321312055952038550000203010436115000
BARBARA PENNYPACKER
1420000532900000208700168199000
CHARLES MCGURK MD
3085290765300000129010329083000
JAY SHAH MD
26856301000000000247510303314000
RUSSETT BURKETT MD
2623000000000247510287051000
MARC HARRIS MD
25042902100000000162680287697000
JAMES RAFTIS MD
24690001800000000247510289651000
DAVID CHANNIN MD
01498290250000000021243019607200
JOSEPH SAWYER
131010049700929000192360156145000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AQUESTIONS REGARDING COMPENSATIONGROSS-UP PAYMENTS ARE PERIODICALLY PROVIDED TO EMPLOYEES. ALL PAYMENTS ARE MADE PURSUANT TO WRITTEN ORGANIZATIONAL POLICIES.
PART I, LINE 3QUESTIONS REGARDING COMPENSATIONEXECUTIVE COMPENSATION IS GENERALLY ESTABLISHED WITHIN A WRITTEN EMPLOYMENT AGREEMENT. COMPENSATION IS DETERMINED BASED ON MARKET STUDIES, PRESENTED TO THE EXECUTIVE COMPENSATION COMMITTEE, and subsequently approved by the board of directors.

Schedule M IRS990ScheduleM

Works Of Art WorksOfArt

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F9903456NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory
Drugs And Medical SuppliesDrugsAndMedicalSupplies
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierFORM 990 SCHEDULE O DISCLOSURESIdentifier
ExplanationForm 990 Part IV Line 12 The organization's financial statements were audited on a consolidated basis with Guthrie Health and Affiliates. Form 990 Part VI Line 6 Guthrie Healthcare System is the sole member of Robert Packer Hospital. Form 990 Part VI Line 7a As the sole member of Robert Packer Hospital, Guthrie Healthcare System appoints the organization's Board of Directors. Form 990 Part VI Line 7b As the sole member of Robert Packer Hospital, Guthrie Healthcare System has approval rights of certain board decisions. Form 990 Part VI Line 11 The organization's Form 990 is presented to the Board of Directors for review and is also reviewed by the organization's finance personnel and an independent accounting firm prior to filing with the IRS. Form 990 Part VI Line 12c The Conflict of Interest Disclosure Policy sets forth that all persons, including employees, agents and Board/Committee members, particularly those involved in decision-making for Guthrie Health (GH), act in an appropriate manner and will not participate in any actions that might create a personal or professional conflict of interest and/or not be in the best interest of GH. All members of any GH Board/Committee and GH senior management must make full disclosure of any possible conflict of interest through the use of the Conflict of Interest Disclosure Form and refrain from voting or participating in decision-making involving any possible conflict of interest. The form is distributed to all Board/Committee members, and employees (when applicable) annually by the GH Administration office. GH Board/Committee members or employees must complete the Conflict of Interest Disclosure Form. This form should be completed when there is any situation where a possible conflict of interest exists, and/or on an annual basis and/or at the time of appointment or election of new Board/Committee members. If the form is not completed within 13 months of the last signing, the GH Board Chairman will be advised. Any individual having a conflict of interest or possible conflict of interest on any manner should excuse themselves from the portion of the meeting or meetings where the matter is discussed and not vote or use his or her personal influence on the matter. The minutes of the meeting or meetings should reflect the disclosure, the abstention from voting, and any action taken to determine whether a conflict of interest existed. Form 990 Part VI Line 15a Executive compensation is generally established within a written employment agreement. Compensation is determined based on market studies, presented to the Executive Compensation Committee, and subsequently approved by the Board of Directors. Form 990 Part VI Line 15b Executive compensation is generally established within a written employment agreement. Compensation is determined based on market studies, presented to the Executive Compensation Committee, and subsequently approved by the Board of Directors. Form 990 Part VI Line 18 The organization's Form 1023, 990, and 990-T are available for public inspection upon request. Form 990 Part VII Line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990 Part VII Section A Average hours per week devoted to related organizations: Daniel J. Brown, MD Member BOD 40 hours per week Surya Narayanan, MD Member BOD 40 hours per week Burdett R. Porter, MD Member BOD 40 hours per week. Daniel Sporn, MD Member BOD 40 hours per week Minh Dang, CFO 1 hour per week Bonnie Onofre, Chief Nursing Officer 6 hours per week Anthony Oliva, DO, Chief Medical Officer 8 hours per week Barbara Pennypacker, VP Surgical Services 14 hours per week Joseph Sawyer, VP Imaging & Ancillary Testing 14 hours per week Form 990 Schedule D, Part X Due To Affiliates Robert Packer Hospital has been allocated certain proceeds of tax-exempt bonds that were issued to Guthrie Health (EIN: 23-3055017). As such, all of the tax-exempt bond reporting for Guthrie Health and its affiliates has been made on Guthrie Health's Form 990. Form 990 Part XI Line 5 Other changes in net assets = $22,203,601Explanation

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (16 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
GUTHRIE HEALTHCARE SYSTEM
ONE GUTHRIE SQUARESAYREPA18840232200910SUPPORTINGPA501 (C)(3)11C - IIIGHfalse
SAYRE HOUSE OF HOPE
ONE GUTHRIE SQUARESAYREPA18840203979472HEALTH CAREPA501 (C)(3)7GHStrue
DONALD GUTHRIE FOUNDATION
200 SOUTH WILBUR AVENUESAYREPA18840246022957MED RESEARCHPA501 (C)(3)4GHStrue
ROBERT PACKER HOSPITAL SCHOOL OF NURSING
200 SOUTH WILBUR AVENUESAYREPA18840236408773EDUCATIONPA501 (C)(3)2GHStrue
TROY COMMUNITY HOSPITAL INC
101 Elmira StreetTROYPA16947240800337HEALTH CAREPA501 (C)(3)3GHStrue
TIOGA HEALTHCARE FACILITY
ONE GUTHRIE SQUARESAYREPA18840150532257HEALTH CAREPA501 (C)(3)3GHStrue
SAYRE HOUSE INC
1001 NORTH ELMER AVENUESAYREPA18840231643404NURSING FACPA501 (C)(3)9GHStrue
GUTHRIE HOME CARE
421 Tomahawk RoadTOWANDAPA18848232394345HOME HEALTHPA501 (C)(3)9GHStrue
GUTHRIE CORNING DEVELOPMENT COMPANY INC
176 DENISON PARKWAY ECORNINGNY14830161594628SUPPORTINGNY501 (C)(3)11B TYPE IIGHStrue
GUTHRIE SAME DAY SURGERY CENTER INC
ONE GUTHRIE SQUARESAYREPA18840020551081AMBULATORYNY501 (C)(3)9GHStrue
GUTHRIE RISK RETENTION GROUP
151 MEETING STREETCHARLESTONSC29401201090801SUPPORTINGSC501 (C)(3)11A TYPE 1GHtrue
TIOGA NURSING FACILITY
ONE GUTHRIE SQUARESAYREPA18840222979677NURSING FACNY501 (C)(3)3GHStrue
GUTHRIE CLINIC LTD
ONE GUTHRIE SQUARESAYREPA18840250815795HEALTH CAREPA501 (C)(3)3GHtrue
DARWAY NURSING HOME INC
ONE GUTHRIE SQUARESAYREPA18840231733967NURSING FACPA501 (C)(3)9GHStrue
CORNING HOSPITAL
176 DENISON PARKWAY ECORNINGNY14830160393490HEALTH CARENY501 (C)(3)3GHStrue
GUTHRIE HEALTH
ONE GUTHRIE SQUARESAYREPA18840233055017SUPPORTINGPA501 (C)(3)11B TYPE IINAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1TWIN TIER MANAGEMENT CORP INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 310AddressLine1
CitySAYRECity
StatePAState
ZIP Code18840ZIPCode
FieldValueIRS element (for citing)
EIN232209439EIN
Primary ActivityMANAGEMENTPrimaryActivity
Legal Domicile StatePALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC CORPTypeOfEntity
Share Of Total Income5907461ShareOfTotalIncome
Share Of EOY Assets5406163ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiestrueReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgtrueSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgtruePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (17 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
GUTHRIE CLINIC
A447722CONTRACT AGREE
GUTHRIE CLINIC
I447722CONTRACT AGREE
GUTHRIE CLINIC
K1291340CONTRACT AGREE
GUTHRIE CLINIC
P916299CONTRACT AGREE
GUTHRIE CLINIC
O60012CONTRACT AGREE
GUTHRIE CLINIC
L18467185CONTRACT AGREE
CORNING HOSPITAL
K1060515CONTRACT AGREE
CORNING HOSPITAL
F91890ASSET VALUE
GUTHRIE HOME CARE
K142366CONTRACT AGREE
TROY COMMUNITY HOSPITAL
K679126CONTRACT AGREE
TROY COMMUNITY HOSPITAL
P316699DIRECT COST EXP
GUTHRIE SAME DAY SURGERY CENTER INC
K52904CONTRACT AGREE
ROBERT PACKER SCHOOL OF NURSING
P125436DIRECT COST EXP
ROBERT PACKER SCHOOL OF NURSING
J100584DIRECT COST EXP
DONALD GUTHRIE FDN FOR EDUCATION & RESEARCH
P192120DIRECT COST EXP
DONALD GUTHRIE FDN FOR EDUCATION & RESEARCH
B52239DIRECT COST EXP
SAYRE HOUSE INC
R195919ASSET VALUE

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