2011-05-12T12:12:56-05:00 2010-06-30 BKD LLP 910 E St Louis Street Suite 200 Springfield MO 65806 990 2009-07-01 232449454 Susquehanna Physician Services SUSQ 5703207900 1201 Grampian Boulevard Williamsport PA 17701 Charles J Santangelo 5703213171 2011-05-12 4178658701 2009 2016-02-24 21:20:13Z Susquehanna Health Medical Group Steven P Johnson 777 Rural Avenue Williamsport PA 17701 69335536 0 X www.susquehannahealth.org X 1987 PA To effect a continuum of compassionate care which assures quality for our patients and value for those who provide it. 18 5 557 30 30133 -11156 8000000 16638978 45977898 45704434 100 0 1153493 6992124 55131491 69335536 0 0 44013416 48781611 0 0 12518111 15445870 56531527 64227481 -1400036 5108055 10684805 15962836 10334585 10504560 350220 5458276 Susquehanna Physician Services is a subsidary of Susquehanna Health System(SHS). The mission of SHS 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 high quality patient centered integrated delivery system. Our values are to demostrate extraordinary CARE for those who receive our services; share owenership with those who provide our services; and be servant leaders whose behaviors are rooted in quality service, dedicated partnership, responsible stewardship, and commitment to our regional community. 0 0 56168808 47468952 Susquehanna Physician Services (SPS) is comprised of a groupof primary care and specialty physicians,The services primarily serve Lycoming and surrounding counties. For fiscal year ended June 20, 2010there were approximately 514,000 patient visits for SPS. 2884643 5197473 Susquehanna Physician Services operates an outpatient MRI center that services patients from Lycoming and surrounding communities. During the fiscal year ended 6/30/10 the center did 8,375 scans. 59053451 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 557 0 1 1 0 0 0 0 0 0 0 0 18 5 0 0 0 0 1 1 1 1 1 0 0 0 0 1 1 1 1 0 PA X Management 5703268756 1201 Grampian Blvd Williamsport PA 17701 Steven Johnson 40.00 X X 0 497381 82981 Dr Alexander Nesbitt 40.00 X X 185359 0 28790 Charles Santangelo 40.00 X X 0 290174 22871 Dr George Manchester 40.00 X X 0 289814 33574 Dr Terry Belles 40.00 X X 226712 0 26217 James Turri 40.00 X X 200208 0 17680 Dr William McCauley 40.00 X 360298 0 32869 Dr William Pagana 40.00 X 322454 0 27176 Paul Rooney 1.00 X 0 0 0 James Douthat Ed D 1.00 X 0 0 0 Lynda Livingston 40.00 X 0 0 0 Dr William Keenan 40.00 X 162430 0 28568 James Campbell Ed D 1.00 X 0 0 0 Dr Frank Parker 40.00 X 136040 0 23149 Ann Pepperman Esquire 1.00 X 0 0 0 Dr Rene Rigal 40.00 X 410012 0 28837 Dr Susan Branton 40.00 X 474127 0 27184 Dr Stephen Weber 40.00 X 235209 0 20206 Neil G Armstrong 40.00 X 0 261117 21029 Dr Sabrina Dowd 40.00 X 664843 0 28476 Dr Ahmet Gurbuz 40.00 X 642380 0 27184 Dr Ronald E DiSimone 40.00 X 845755 0 18442 Dr Warren L Robinson 40.00 X 793750 0 9448 Dr Edward Wyshock 40.00 X 904162 0 26742 6563739 1338486 531423 103 0 1 0 McKesson Specialty Care Dist 15212 Collections Center Drive Chicago IL 60693 Pharmacueticals 1000271 Susquehanna Imaging Associates 777 Rural Ave Williamsport PA 17701 MRI Scans 870255 Comphealth Medical Staffing PO Box 972651 Dallas TX 75397 Temporary Employment 556743 Aramark Healthcare 24863 Network Place Chicago IL 60673 Management/environmental sevices 469232 ECG Management Consultants 1111 Third Ave Suite 2700 Seattle WA 98101 Consulting Services 427796 13 16595364 43614 43614 16638978 Net Patient Services 621110 39394753 39394753 MRI Scans 621400 5190593 5190593 Capitation Payments 621110 1119088 1119088 45704434 Inter-Entity SSA 621110 5660051 5660051 Inter-Entity Revenue 621110 298051 298051 Medical Director Rev 621110 207154 207154 826868 796735 30133 6992124 69335536 52666425 30133 0 2680774 2192328 488446 38379598 36586327 1793271 1413581 1351844 61737 4147096 3965976 181120 2160562 2066202 94360 334605 334605 2475 2475 17788 17788 1534218 993766 540452 151573 151573 4627421 4284673 342748 347272 342943 4329 2685794 2298138 387656 60427 19900 40527 221429 192711 28718 106264 106264 1377539 734415 643124 1621317 1547415 73902 Provision For Bad Debt 1574929 1574929 Minor Equipment 221737 189229 32508 Equipment Rentals 36027 36027 525055 525055 64227481 59053451 5174030 0 280031 359647 4225908 5171981 36570 445823 904865 400000 400000 360880 486150 19111695 10528929 4951306 8582766 20857 20857 10684805 15962836 9550585 9632560 784000 872000 10334585 10504560 X 350220 5458276 350220 5458276 10684805 15962836 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41973 41973 373321 373321 0 1751289 961596 789693 12853720 9069800 3783920 4091392 124212 3967180 8582766 Third Party Payors 872000 872000 69335536 64227481 5108055 0 5108055 52696558 0 52696558 16638978 16638978 69335536 64227480 0 64227480 0 64227480 Part X Line 2- Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, maanagement has not indentified any material uncertain tax positions to be recorded or disclosed in the financial statements. Part XII Line 4b- Susquehanna Physician Services received financial support from the following related entites The Williamsport Hospital & Medical Center $7,262,236, Divine Providence Hospital $6,532,778, and Muncy Valley Hospital $2,800,350. Central America 0 1 Program Services Captive insurance company 1133515 0 1 1133515 X X X X X 0 1 0 0 0 0 0 0 0 Steven Johnson 0 488422 0 0 0 8959 0 68748 0 14233 0 580362 0 0 Dr Alexander Nesbitt 184757 0 0 0 602 0 9448 0 19342 0 214149 0 0 0 Charles Santangelo 0 286557 0 0 0 3617 0 8400 0 14471 0 313045 0 0 Dr George Manchester 0 288008 0 0 0 1806 0 11850 0 21724 0 323388 0 0 Dr Terry Belles 225408 0 0 0 1304 0 13185 0 13032 0 252929 0 0 0 James Turri 195649 0 0 0 4559 0 11106 0 6574 0 217888 0 0 0 Dr William McCauley 356687 0 0 0 3611 0 15875 0 16994 0 393167 0 0 0 Dr William Pagana 322034 0 0 0 420 0 8400 0 18776 0 349630 0 0 0 Dr William Keenan 161394 0 0 0 1036 0 8754 0 19814 0 190998 0 0 0 Dr Frank Parker 135054 0 0 0 986 0 8159 0 14990 0 159189 0 0 0 Dr Rene Rigal 407240 0 0 0 2772 0 15875 0 12962 0 438849 0 0 0 Dr Susan Branton 473707 0 0 0 420 0 8400 0 18784 0 501311 0 0 0 Dr Stephen Weber 234384 0 0 0 825 0 10368 0 9838 0 255415 0 0 0 Neil G Armstrong 0 258400 0 0 0 2717 0 14092 0 6937 0 282146 0 0 Dr Sabrina Dowd 664423 0 0 0 420 0 8400 0 20076 0 693319 0 0 0 Dr Ahmet Gurbuz 641960 0 0 0 420 0 8400 0 18784 0 669564 0 0 0 Dr Ronald E DiSimone 820383 0 0 0 25372 0 0 0 18442 0 864197 0 0 0 Dr Warren L Robinson 791944 0 0 0 1806 0 8400 0 1048 0 803198 0 0 0 Dr Edward Wyshock 903196 0 0 0 966 0 8400 0 18342 0 930904 0 0 0 Supplemental Information Part III Part I, Line 4b: Steven P. Johnson $56,898 Dr Ronald DiSimone Physician Sign On Bonus X 70000 36570 0 0 1 36570 X Furniture 1 43614 Actual Cost 0 0 0 0 Method for Determining Number of Contributors: Part I, Column (b): Waiting room furniture was donated for the new medical plaza. Form 990, Part VI, Section A, line 6 Susquehanna Health System, EIN #23-2751183, is the sole member of the governing body Form 990, Part VI, Section A, line 7a Susquehanna Health System, 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 corporation shall be managed and controlled by the Board of Directors, subject to the oversight of the Member of the management and operation of the corporation, except that the following powers are reserved exclisively to the sole Member of the coporation, and no attempte exercise of any such powers by anyone other than the sole Member shall be valid or of any force or effect whatsoever. The sole member shall exercise its power through its Board of Directors. The Memeber shall have exclusive authority to exercise the following powers: A. To approve the appointment and removal of the President of the corporation. B. To elect and remove, with or without cause, a Director of the corporation. C. To establish the overall policy and long range plans of the corporation,determine or change the mission of the corporation, approve the programs, and services of the corporation, and monitor and maintain the philosophy, goals and purposes for which the corporation was formed and exists. D. To adopt, amend or repeal the Articles of Incorporation or the bylaws. E. To establish requirements for a unified budget, the approval of new capital debt, any increment to any existing capital debt, and/or any change in the capital debt obligations of the corporation. F. To establish requirements for the approval of the aquisution,purchase,sale,leasing outside the ordinary course of business, transfer outside the ordinary cause of business or ecumbrance outside the normal course of businss of land or buildings and the construction of demolition of buildings owned by the corporation. G. To require a certified audit of corporate funds at any time. H. To approve any gauranty of indebtedness of any person, the granting of any security interest in or the creation of any encumburance on any asset of the corporation outside the ordinary course of business, or any transfer of any asset of the corporation outside the normal course of business, except transfers between or among affliated corporations. I. To approve any merger,consolidation,orginization,reorganization,joint venture or other modification of corporate structure or affliations affecting to autonomy,goverance or operations of the corporation. J. To dissolve or terminate the existence of the corporation and detirmine the distibution of assets upon such termination or dissolution, as provided in the bylaws. K. To appoint annually the external fiscal auditor of the corporation. L. To approve the nominees for elected officers of the Board of Directors of the corporation and to return the list of approved nominees to the Board of Directors for election. M. To remove any elected officer of the corporation. N. To approve the annual capital and operating budget of the corporation. O. To coordinate managed care plans, including decisions concerning entry into or renewal of ay contract or agreement relating thereto. Form 990, Part VI, Section B, line 11 The IRS 990 was first reviewed by an independent accounting firm, then senior management, then with Board members at a combined Susquehanna Health Sysytem Finance/Executive/Audit & Compliance committee meeting prior to e-filing. Form 990, Part VI, Section B, line 12 As required by law, SPS policy states that all members of the Board of Managers must sign a statement each year disclosing any confilct of interest that may arise and agree to abstain when issues involving those parties with conflicting interests are called to motion. Any conflicts of interest are reviewed by the System's attorneys. Form 990, Part VI, Section B, line 15 The board of directors, through the Executive Committee, retains an independent outside consultant to provide guidance with respect to the annual establishment of the rebuttable presumption or reasonableness relative to executive compensation and benefits. The consultant annually provides detailed market information from its annual Executive Compensation Survey of Health Systems. In addition, other regional survey data is provided in order to supply the health system with a "national" picture of compensation. With this process established, the executive compensation committee takes the proper steps to educate the Board of Directors to understand all of the above mentioned oversight and to appropriately prepare them for community or media inquiry. In addition, the Board is made aware of the form 990 and its role in the communication of information to the public. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. The Williamsport Hospital and Medical Center 777 Rural Avenue Williamsport PA 17701 240795508 Hospital PA 501 (c) (3) 3 N/A Divine Providence Hospital of the Sisters of Christian Charity 1100 Grampian Blvd Williamsport PA 17701 240799343 Hospital PA 501 (c) (3) 3 N/A Muncy Valley Hospital 215 East Water Street Muncy PA 17756 240806023 hospital PA 501 (c) (3) 3 N/A Susquehanna Health Foundation 1100 Grampian Blvd Williamsport PA 17701 232743470 Fundraising and affiliated activities PA 501 (c) (3) 11 N/A Susquehanna Health System 1205 Grampian Blvd Williamsport PA 17701 232751183 Coordinate & manage the delivery of healthcare PA 501 (c) (3) 11 N/A Providence Cancer Treatment Services 1100 Grampian Blvd Williamsport PA 17701 232925354 Outpatient radiation therapy services PA 501 (c) (3) 3 N/A Community Basket LLC 1205 Grampian Blvd Williamsport PA 17701 201195739 Rents real estate PA Susquehanna Health System & Susquehanna Health excluded from tax 0 0 Susquehanna Ventures 1201 Grampian Blvd Williamsport PA 17701 232470263 Pharmacy and infusion services PA N/A C Williamsport Area Ambulance Service Cooperative 1205 Grampian Blvd Williamsport PA 17701 232416166 Ambulance Transport PA N/A C Central PA Provider Network 1205 Grampian Blvd Williamsport PA 17701 232949121 Physicians Insurance PA N/A C Susquehanna Health System Insurance Network LTD PO Box 1159 Grand Caymans CJ KY1-1102 980458722 Captive insurance company CJ N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0