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Nonprofiteer
← THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA

Form 990 for tax year 2022

Filed by THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA.

Totals

Total revenue
$286,142,172
Total expenses
$293,910,564
Contributions and grants received
$4,342,774
Grants paid
$150,693
Program service revenue
$281,247,948
Investment income
$254,676
Other revenue
$296,774
Total assets, end of year
$116,393,015
Total liabilities, end of year
$142,663,596
Net assets or fund balances, end of year
-$26,270,581
Program services expenses (Part IX)
$220,375,676
Management and general expenses
$73,534,888
Fundraising expenses
$0
Program service expenses (Part III)
$220,375,676

Program services were 75.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1d · Related organizations

    $143,806

  • 1e · Government grants (contributions)

    $3,969,111

  • 1f · All other contributions, gifts and grants

    $229,857

  • 2a · Program service revenue: PATIENT SERVICES

    total $281,239,380 · related or exempt $279,625,271 · unrelated business $1,614,109

  • 2b · Program service revenue: FUNDRAISING FEES

    total $8,568 · related or exempt $8,568

  • 3 · Investment income

    total $18,568 · excluded $18,568

  • 6a · Gross rents

    real property $821,901

  • 6b · Less rental expenses

    real property $1,312,644

  • 6c · Rental income or loss

    real property -$490,743

  • 6d · Net rental income or loss

    total -$490,743 · excluded -$490,743

  • 7a · Gross sales of assets other than inventory

    securities $8,390,177 · other assets $4,037

  • 7b · Less cost or other basis and sales expenses

    securities $8,108,106 · other assets $50,000

  • 7c · Gain or loss

    securities $282,071 · other assets -$45,963

  • 7d · Net gain or loss

    total $236,108 · excluded $236,108

  • 11a · Other revenue: CAFETERIA SALES

    total $643,400 · excluded $643,400

  • 11b · Other revenue: HOUSEKEEPING SERVICES

    total $55,831 · excluded $55,831

  • 11c · Other revenue: HEALTH PROMOTION

    total $46,545 · excluded $46,545

  • 11d · All other revenue

    total $41,741 · excluded $41,741

  • 11e · Other revenue, total

    $787,517

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $120,000 · program services $120,000

  • 2 · Grants to domestic individuals

    total $30,693 · program services $30,693

  • 5 · Compensation of officers, directors and key employees

    total $1,248,431 · management and general $1,248,431

  • 7 · Other salaries and wages

    total $65,352,959 · program services $60,783,767 · management and general $4,569,192

  • 8 · Pension plan contributions

    total $3,698,206 · program services $3,534,722 · management and general $163,484

  • 9 · Other employee benefits

    total $14,579,760 · program services $11,449,918 · management and general $3,129,842

  • 10 · Payroll taxes

    total $4,936,583 · program services $4,569,723 · management and general $366,860

  • 11a · Fees: management

    total $52,192,097 · management and general $52,192,097

  • 11b · Fees: legal

    total $26,189 · management and general $26,189

  • 11c · Fees: accounting

    total $86,977 · management and general $86,977

  • 11d · Fees: lobbying

    total $12,542 · management and general $12,542

  • 11f · Fees: investment management

    total $58,716 · management and general $58,716

  • 11g · Fees: other

    total $61,148,420 · program services $59,190,516 · management and general $1,957,904

  • 12 · Advertising and promotion

    total $9,879 · program services $8,573 · management and general $1,306

  • 13 · Office expenses

    total $724,708 · program services $480,973 · management and general $243,735

  • 14 · Information technology

    total $494,668 · program services $425,601 · management and general $69,067

  • 16 · Occupancy

    total $3,164,012 · program services $1,096,542 · management and general $2,067,470

  • 17 · Travel

    total $100,352 · program services $95,703 · management and general $4,649

  • 19 · Conferences, conventions and meetings

    total $65,183 · program services $56,570 · management and general $8,613

  • 20 · Interest

    total $10,791,391 · program services $10,791,391

  • 22 · Depreciation, depletion and amortization

    total $6,988,373 · program services $6,980,698 · management and general $7,675

  • 23 · Insurance

    total $2,078,250 · program services $2,078,250

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $44,208,645 · program services $44,208,645

  • 24b · Other expenses: BAD DEBT

    total $11,723,685 · program services $11,723,685

  • 24c · Other expenses: REPAIRS & MAINTENANCE

    total $4,409,573 · program services $1,171,304 · management and general $3,238,269

  • 24d · Other expenses: TAXES & LICENSES

    total $4,127,700 · program services $117,639 · management and general $4,010,061

  • 24e · All other expenses

    total $1,532,572 · program services $1,460,763 · management and general $71,809

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $4,586 · end of year $2,867

  • 2 · Savings and temporary cash investments

    beginning of year $113,109 · end of year $10,678

  • 3 · Pledges and grants receivable

    beginning of year $717,516 · end of year $540,000

  • 4 · Accounts receivable

    beginning of year $27,070,603 · end of year $28,761,215

  • 8 · Inventories for sale or use

    beginning of year $4,329,854 · end of year $4,851,235

  • 9 · Prepaid expenses and deferred charges

    beginning of year $377,112 · end of year $333,367

  • 10a · Land, buildings and equipment: cost or other basis

    $177,838,910

  • 10b · Land, buildings and equipment: accumulated depreciation

    $117,267,364

  • 10c · Land, buildings and equipment, net

    beginning of year $62,614,151 · end of year $60,571,546

  • 11 · Investments: publicly traded securities

    beginning of year $12,686,581 · end of year $13,781,822

  • 12 · Investments: other securities

    beginning of year $1,603,666 · end of year $1,796,502

  • 13 · Investments: program-related

    beginning of year $3,870,035 · end of year $4,273,010

  • 14 · Intangible assets

    beginning of year $3,817,462 · end of year $1,247,731

  • 15 · Other assets

    beginning of year $279,083 · end of year $223,042

  • 17 · Accounts payable and accrued expenses

    beginning of year $22,757,179 · end of year $20,451,114

  • 19 · Deferred revenue

    beginning of year $3,984,317 · end of year $2,247,119

  • 20 · Tax-exempt bond liabilities

    beginning of year $2,129,396 · end of year $2,066,817

  • 23 · Secured mortgages and notes payable

    beginning of year $123,532,774 · end of year $0

  • 25 · Other liabilities

    beginning of year $56,927,033 · end of year $117,898,546

  • 27 · Net assets without donor restrictions

    beginning of year -$99,433,868 · end of year -$33,889,394

  • 28 · Net assets with donor restrictions

    beginning of year $7,586,927 · end of year $7,618,813

Mission and programs · 2022

Mission

THE GOOD SAMARITAN HOSPITAL IS A TAX-EXEMPT ORGANIZATION DEDICATED TO PROVIDING HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF THE COMMUNITY.

Activities or mission (Part I)

PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE TO IMPROVE OVERALL HEALTH OF THE COMMUNITY.

  • THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA HAS BEEN PROVIDING POWERFUL MEDICINE AND COMFORTING CARE TO THE RESIDENTS OF LEBANON COUNTY FOR MORE THAN 125 YEARS.AS THE COMMUNITY HOSPITAL OF THE LEBANON VALLEY REGION, THE GOOD SAMARITAN HOSPITAL OF LEBANON, PENNSYLVANIA OFFERS A WIDE VARIETY OF ACUTE CARE AND OUTPATIENT SERVICES THAT HELP IMPROVE THE HEALTH OF OUR COMMUNITY. THE SECHLER FAMILY CANCER CENTER IS LEBANON COUNTY'S FIRST AND ONLY INTEGRATED CANCER CENTER PROVIDING MEDICAL AND RADIATION ONCOLOGY IN A STATE OF THE ART FACILITY WITH A WARM AND HEALING ENVIRONMENT.THE STATE-OF-THE-ART CARDIAC & VASCULAR CENTER HAS WON NATIONAL AWARDS FROM THE AMERICAN HEART ASSOCIATION. THE CENTER HAS ALSO BEEN DESIGNATED AS A BLUE DISTINCTION CENTER FOR CARDIAC CARE BY HIGHMARK BLUE SHIELD. DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY IS OFFERED, AS WELL AS ELECTROPHYSIOLOGY AND OPEN HEART SURGERY. THE NEW BEGINNING BIRTH SUITES OFFER A ONE-STOP EXPERIENCE FOR LABOR, DELIVERY AND RECOVERY IN A FAMILY-FRIENDLY SETTING.THE GOOD SAMARITAN CENTER FOR WOUND CARE & HYPERBARIC MEDICINE HAS CREATED NEW HOPE FOR THOSE WITH NON-HEALING WOUNDS. THE HOSPITAL OFFERS A NETWORK OF LABORATORY AND IMAGING CENTERS THROUGHOUT LEBANON COUNTY.SEE WELLSPAN HEALTH - 2023 COMMUNITY BENEFIT REPORT LOCATED AT HTTPS://WWW.WELLSPAN.ORG/ABOUT/WELLSPAN-IN-THE-COMMUNITY/2023-COMMUNITY-BENEFIT-REPORT/.

    Expenses $220,375,676 · Grants $150,693 · Revenue $279,633,839

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Moniqua Acosta

    CHAIR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Reyna Britton RN

    DIRECTOR, VICE CHAIR (AS OF 1/23)

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Roxanna Gapstur PhD RN

    PRESIDENT & CEO - WELLSPAN HEALTH

    Total calculated
    $2,391,449
    From this org
    $0
    From related orgs
    $2,303,962
    Other
    $87,487
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,523,876 related
    Bonus
    $0 + $780,000 related
    Other
    $0 + $86 related
    Deferred
    $0 + $13,477 related
    Nontaxable benefits
    $0 + $74,010 related
    Filer's total
    $0 + $2,391,449 related
  • Carrie Wilson

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Christopher Grant Psy D

    DIRECTOR

    Total calculated
    $2,023
    From this org
    $0
    From related orgs
    $1,780
    Other
    $243
    Hours/week
    1 + 40 related
  • Kimberly Kreider Umble

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Stephen Lindsey

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Michael Seim

    SR VP & CHIEF QUALITY OFFICER

    Total calculated
    $975,892
    From this org
    $0
    From related orgs
    $904,525
    Other
    $71,367
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $660,561 related
    Bonus
    $0 + $243,904 related
    Other
    $0 + $60 related
    Deferred
    $0 + $15,485 related
    Nontaxable benefits
    $0 + $55,882 related
    Filer's total
    $0 + $975,892 related
  • Robert Funk

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Robert Hoffman

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 4 related
  • Edward Tadajweski MD

    DIRECTOR

    Total calculated
    $758,007
    From this org
    $0
    From related orgs
    $687,229
    Other
    $70,778
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $518,654 related
    Bonus
    $0 + $168,575 related
    Other
    $0
    Deferred
    $0 + $18,351 related
    Nontaxable benefits
    $0 + $52,427 related
    Filer's total
    $0 + $758,007 related
  • Laura Buczkowski

    EXECUTIVE VP & CFO - WELLSPAN HEALTH

    Total calculated
    $1,018,368
    From this org
    $0
    From related orgs
    $944,343
    Other
    $74,025
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $694,583 related
    Bonus
    $0 + $249,750 related
    Other
    $0 + $10 related
    Deferred
    $0 + $16,892 related
    Nontaxable benefits
    $0 + $57,133 related
    Filer's total
    $0 + $1,018,368 related
  • Roger Zimmerman

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Amanda Davis-Buie

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Vincent Garcia

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Faraaz Yousuf

    EXEC. VP & COO (UNTIL 11/22)

    Total calculated
    $1,032,704
    From this org
    $0
    From related orgs
    $987,746
    Other
    $44,958
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $563,091 related
    Bonus
    $0 + $401,869 related
    Other
    $0 + $22,786 related
    Deferred
    $0 + $3,087 related
    Nontaxable benefits
    $0 + $41,871 related
    Filer's total
    $0 + $1,032,704 related
  • James Stuccio

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1 + 3 related
  • Amy Nelson

    SECRETARY/SR VP & GENERAL COUNSEL

    Total calculated
    $749,817
    From this org
    $0
    From related orgs
    $661,328
    Other
    $88,489
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $477,341 related
    Bonus
    $0 + $173,900 related
    Other
    $0 + $10,087 related
    Deferred
    $0 + $38,242 related
    Nontaxable benefits
    $0 + $50,247 related
    Filer's total
    $0 + $749,817 related
  • Carrie Willetts

    SR VP - EAST REGION (UNTIL 7/22)

    Total calculated
    $618,509
    From this org
    $0
    From related orgs
    $567,828
    Other
    $50,681
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $276,897 related
    Bonus
    $0 + $173,160 related
    Other
    $0 + $117,771 related
    Deferred
    $0 + $12,435 related
    Nontaxable benefits
    $0 + $38,246 related
    Filer's total
    $0 + $618,509 related
  • Patricia Donley

    PRESIDENT

    Total calculated
    $407,961
    From this org
    $361,891
    From related orgs
    $0
    Other
    $46,070
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $282,216
    Bonus
    $62,700
    Other
    $16,975
    Deferred
    $15,953
    Nontaxable benefits
    $30,117
    Filer's total
    $407,961
  • Robert Shaver

    VP - MEDICAL AFFAIRS (UNTIL 4/23)

    Total calculated
    $490,627
    From this org
    $425,710
    From related orgs
    $0
    Other
    $64,917
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $344,859
    Bonus
    $74,164
    Other
    $6,687
    Deferred
    $18,668
    Nontaxable benefits
    $46,249
    Filer's total
    $490,627
  • Kelly Smith

    VP PATIENT CARE SERVICES

    Total calculated
    $280,685
    From this org
    $224,695
    From related orgs
    $0
    Other
    $55,990
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $197,349
    Bonus
    $23,210
    Other
    $4,136
    Deferred
    $13,000
    Nontaxable benefits
    $42,990
    Filer's total
    $280,685
  • Jilian White MD

    VP - MEDICAL AFFAIRS

    Total calculated
    $423,219
    From this org
    $0
    From related orgs
    $378,648
    Other
    $44,571
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $353,722 related
    Bonus
    $0 + $24,851 related
    Other
    $0 + $75 related
    Deferred
    $0 + $11,463 related
    Nontaxable benefits
    $0 + $33,108 related
    Filer's total
    $0 + $423,219 related
  • Virginia Sanger

    SR DIR. ANCILLARY & SUPPORT SERVICES

    Total calculated
    $265,949
    From this org
    $214,867
    From related orgs
    $0
    Other
    $51,082
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $197,155
    Bonus
    $13,708
    Other
    $4,004
    Deferred
    $24,555
    Nontaxable benefits
    $26,527
    Filer's total
    $265,949
  • Debra Ney

    MANAGER-PHARMACY

    Total calculated
    $246,404
    From this org
    $206,917
    From related orgs
    $0
    Other
    $39,487
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $190,504
    Bonus
    $13,018
    Other
    $3,395
    Deferred
    $11,502
    Nontaxable benefits
    $27,985
    Filer's total
    $246,404
  • Bonnie Pietruch

    DIRECTOR CLINICAL OPERATIONS

    Total calculated
    $204,502
    From this org
    $178,917
    From related orgs
    $0
    Other
    $25,585
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $163,647
    Bonus
    $11,934
    Other
    $3,336
    Deferred
    $10,555
    Nontaxable benefits
    $15,030
    Filer's total
    $204,502
  • Annie Donley

    DIRECTOR CLINICAL PHARMACY SERVICES

    Total calculated
    $229,700
    From this org
    $179,430
    From related orgs
    $0
    Other
    $50,270
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $163,893
    Bonus
    $15,537
    Other
    $0
    Deferred
    $10,852
    Nontaxable benefits
    $39,418
    Filer's total
    $229,700
  • Donna Palmer

    CLINICAL NURSE

    Total calculated
    $227,465
    From this org
    $178,719
    From related orgs
    $0
    Other
    $48,746
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $132,939
    Bonus
    $45,780
    Other
    $0
    Deferred
    $10,344
    Nontaxable benefits
    $38,402
    Filer's total
    $227,465
  • Thomas Harlow

    FORMER PRESIDENT

    Total calculated
    $379,857
    From this org
    $356,714
    From related orgs
    $0
    Other
    $23,143
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $51,506
    Bonus
    $79,752
    Other
    $225,456
    Deferred
    $3,724
    Nontaxable benefits
    $19,419
    Filer's total
    $379,857

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 4B
THE WELLSPAN HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ADOPTED AND MADE EFFECTIVE ON DECEMBER 19TH, 2008. THE OBJECTIVE OF THE EXECUTIVE BENEFITS PROGRAM IS TO PROVIDE AN EXECUTIVE BENEFITS PROGRAM THAT IS COMPETITIVE WITH NATIONAL NORMS IN THE HEALTHCARE INDUSTRY FOR SIMILARLY SIZED ORGANIZATIONS ENABLING WELLSPAN HEALTH TO RECRUIT AND RETAIN TOP EXECUTIVE TALENT. TIER I EXECUTIVES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1) PROVIDE AN EMPLOYER SPONSORED RETIREMENT BENEFIT THAT REPLACES 60% OF AVERAGE PRE-RETIREMENT (5 YEARS) BASE COMPENSATION THROUGH A COMBINED APPROACH UTILIZING WELLSPAN'S RETIREMENT PLAN, 50% OF SOCIAL SECURITY, SPLIT-DOLLAR LIFE INSURANCE BENEFIT, AND SUPPLEMENTAL EXECUTIVE RETIREMENT BENEFIT. 2) PROVIDES A MINIMUM BENEFIT AFTER 10 YEARS OF SERVICE. 3) PROVIDES THE FULL TARGETED BENEFIT AFTER 25 YEARS OF SERVICE. 4) BENEFIT IS VESTED WHEN ELIGIBLE EXECUTIVE REACHES AGE 65. THE BENEFIT IS ALSO VESTED UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5) CREDITED SERVICE GRANTED ON A 1:2 BASIS FOR PREVIOUS SERVICE IN AN ELIGIBLE TIER II POSITION. 6) TARGETED BENEFIT IS TO BE CALCULATED USING A 15 YEAR CERTAIN PAYOUT. 7) PAYOUT WILL BE IN A LUMP SUM. 8) PAYOUT WILL BE TAXABLE WHEN VESTED. DURING THE CALENDAR YEAR 2022, THERE WERE NO DISTRIBUTIONS FROM THE SERP. THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN WAS ADOPTED AND MADE EFFECTIVE AS OF JULY 1, 2017. THIS PLAN WILL REPLACE THE SERP. AS PART OF THE TRANSITION, EACH PARTICIPANT IN THE SERP WAS GIVEN A ONE-TIME CHOICE TO BE GRANDFATHERED IN THE SERP OR TRANSFER TO THE NEW WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN. THE OBJECTIVE OF THE WELLSPAN HEALTH DEFINED CONTRIBUTION DEFERRED COMPENSATION PLAN IS TO ATTRACT AND RETAIN EXECUTIVE AND UPPER-LEVEL MANAGEMENT EMPLOYEES OF OUTSTANDING ABILITY. TIERS I, II, III AND A SELECT GROUP OF TIER IV EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE PLAN. A DESCRIPTION OF THE TARGETED BENEFIT OF THE PLAN IS AS FOLLOWS: 1)PROVIDE AN UNFUNDED DEFERRED COMPENSATION BENEFIT TO A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES. 2)PLAN ACCOUNT CONTRIBUTIONS ARE CREDITED EACH YEAR TO A SUBACCOUNT, BASED UPON VARIOUS TIER LEVELS; TIER I, 22%, TIER II, 17%, TIER III, 12%, AND TIER IV, 8%. 3)PARTICIPANT ACCOUNTS ARE CREDITED INTEREST EACH YEAR BY APPLICATION OF THE 30-YEAR U.S. TREASURY RATE ON JUNE 30 OF THE PLAN YEAR THEN ENDING, PLUS ONE PERCENT (1%). 4)PARTICIPANT VESTING OCCURS ON THE EARLIER OF: A)JUNE 30TH OF THE FOURTH PLAN YEAR: 25% PER YEAR B)PARTICIPANT REACHES AGE 65. C)UPON DEATH, DISABILITY, JOB ELIMINATION AND "TERMINATION FOR GOOD REASON". 5)NON-ELECTIVE EMPLOYER CONTRIBUTIONS ARE ALSO PERMITTED. 6)PLAN DISTRIBUTIONS TO BE ADMINISTERED PER THE PLAN DOCUMENT. DURING THE CALENDAR YEAR 2022, THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS FROM THE DEFERRED COMPENSATION PLAN: CARRIE WILLETTS - $50,621 THOMAS HARLOW - $181,583 ADDITIONALLY, ANY VESTED PORTION OF CONTRIBUTIONS MADE TO THE PLAN WHICH ARE NO LONGER SUBJECT TO THE RISK OF FORFEITURE, ARE REFLECTED IN SCHEDULE J, PART II, COLUMN B(III).

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • APPLE HILL SURGICAL CENTER PARTNERS

    SURGICAL CENTER · PA

    Directly controlled by WELLSPAN HEALTH

  • CHERRY TREE CANCER CENTER LLP

    RADIATION · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • CUMBERLAND VALLEY MOBILE SERVICES

    MOBILE HEALTH SERVICES · PA

    Directly controlled by CHAMBERSBURG HEALTH SERVICES

  • LITTLESTOWN HEALTH CARE PARTNERSHIP

    LEASE FACILITY · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • SUMMIT SURGERY CENTER LP

    PHYSICIAN SERVICES · PA

    Directly controlled by CHAMBERSBURG HEALTH SERVICES

  • SURGERY CENTER ASSOCIATES LLC

    PHYSICIAN SERVICES · PA

    Directly controlled by CHAMBERSBURG HEALTH SERVICES

  • THE REHAB CENTER

    PHYSICAL THERAPY REHABILITATION · PA

    Directly controlled by EPHRATA HOSPITAL

  • WELLSPAN SCA HOLDINGS LLC

    INVESTMENTS · MD

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • APPLE HILL CONDOMINIUM ASSOCIATION

    C · CONDOMINIUM ASSOCIATION · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • CUMBERLAND VALLEY HEALTH NETWORK INC

    C · HEALTH NETWORK · PA

    Directly controlled by WELLSPAN SUMMIT HEALTH

  • EPHRATA HEALTH PAVILION CONDOMINIUM ASSOCIATION

    C · CONDOMINIUM ASSOCIATION · PA

    Directly controlled by EPHRATA HOSPITAL

  • EPHRATA MEDICAL OFFICE CONDOMINIUM ASSOCIATION

    C · CONDOMINIUM ASSOCIATION · PA

  • GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION OF LEBANON PA

    C · HEALTH CARE SERVICES · PA · 50% owned · share of income $47,770 · share of assets $761,108

    Directly controlled by THE GOOD SAMARITAN HOSPITAL OF LEBANON PENNSYLVANIA

  • GSH REALTY INC

    C · NON-RESIDENTIAL REAL ESTATE · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • NORTHERN LANCASTER COUNTY PHYSICIAN HOSPITAL ALLIANCE

    C · COORD PHYS & HOSPITAL · PA

    Directly controlled by EPHRATA HOSPITAL

  • QUEST BEHAVIORAL HEALTH

    C · HEALTH CARE NETWORK SERVICE · PA

    Directly controlled by WELLSPAN HEALTH

  • WELLSPAN HEARING CENTER INC

    C · HEARING AID PRACTICE · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • WELLSPAN PHARMACY INC

    C · DISPENSES RX & PROVIDES IV THERAPY · PA

    Directly controlled by WELLSPAN HEALTH CARE SERVICES

  • WELLSPAN PROVIDER NETWORK

    C · COORDINATE MANAGED CARE RISK CONTRACTS · PA

    Directly controlled by WELLSPAN HEALTH

  • WELLSPAN RECIPROCAL RISK RETENTION GROUP

    C · RISK RETENTION GROUP · PA

    Directly controlled by WELLSPAN HEALTH

  • YORK HEALTH PLAN

    C · PREFERRED PROVIDER ORGANIZATION · PA

    Directly controlled by WELLSPAN HEALTH

Provenance

Return type
form_990
Tax year
2022
Filed
9 May 2024
IRS schema version
2022v5.0
Source object
202411309349301611

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