Civic Intelligence

Good Samaritan Physician Services

990 • Fiscal year 2016 • EIN 25-1832359

Jul 01, 2015 to Jun 30, 2016 • Filed on May 10, 2017

PO Box 2767York, PA 17405

(717) 851-3055

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

99th percentile

2.23x

Higher debt load relative to assets than 99% of similar nonprofits.

2016 filings • 501(c)3 • $25M-$50M nonprofits • Source year 2016

Liabilities / Revenue

50th percentile

0.34x

Higher debt load relative to revenue than 50% of similar nonprofits.

2016 filings • 501(c)3 • $25M-$50M nonprofits • Source year 2016

Net Margin

13th percentile

-14%

Higher net margin than 13% of similar nonprofits.

2016 filings • 501(c)3 • $25M-$50M nonprofits • Source year 2016

Top Officer Pay

98th percentile

$1,882,437

Higher top officer pay than 98% of similar nonprofits.

Top officer pay equals 7.0% of source-year revenue.

2016 filings • 501(c)3 • $25M-$50M nonprofits • Source year 2016

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2016

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2016

Assets

$4,067,006

No earlier filing loaded for comparison.

Net Assets

-$4,990,318

No earlier filing loaded for comparison.

Liabilities

$9,057,324

No earlier filing loaded for comparison.

Revenue

$27,027,557

No earlier filing loaded for comparison.

Expenses

$30,925,977

No earlier filing loaded for comparison.

Net Income

-$3,898,420

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$10M$5.0M$0-$5.0MAssets 2016: $4,067,006Liabilities 2016: $9,057,324Net Assets 2016: -$4,990,3182016Assets 2017: $4,516,315Liabilities 2017: $9,506,633Net Assets 2017: -$4,990,3182017Assets 2018: $0Liabilities 2018: $0Net Assets 2018: $02018Assets 2019: $0Net Assets 2019: $02019Assets 2020: $0Net Assets 2020: $02020Assets 2021: $0Net Assets 2021: $02021Assets 2022: $0Liabilities 2022: $0Net Assets 2022: $02022Assets 2023: $0Liabilities 2023: $0Net Assets 2023: $02023Assets 2024: $3,063,984Liabilities 2024: $0Net Assets 2024: $3,063,9842024

Highlighted filing

2016

Assets$4,067,006
Liabilities$9,057,324
Net Assets-$4,990,318

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$60M$40M$20M$0-$20MRevenue 2016: $27,027,557Expenses 2016: $30,925,977Net Income 2016: -$3,898,4202016Revenue 2017: $42,643,614Expenses 2017: $42,643,614Net Income 2017: $02017Revenue 2018: $5,032,863Expenses 2018: $42,545Net Income 2018: $4,990,3182018Revenue 2019: $02019Revenue 2020: $02020Revenue 2021: $02021Revenue 2022: $0Expenses 2022: $0Net Income 2022: $02022Revenue 2023: $0Expenses 2023: $0Net Income 2023: $02023Revenue 2024: $20,792,133Expenses 2024: $24,288,521Net Income 2024: -$3,496,3882024

Highlighted filing

2016

Revenue$27,027,557
Expenses$30,925,977
Net Income-$3,898,420
Jump To
Filing Snapshot
Filing Period
Jul 1, 2015 to Jun 30, 2016
Signed
May 10, 2017
Return Version
2015v3.0
Gross Receipts
$27,027,557
Mission and Program Overview

Mission

Good Samaritan Physician Services' mission is improving the health of patients and our communities as a multi-specialty group, built on a foundation of primary care and prevention, and coordinated within a comprehensive system of care to deliver exceptional and affordable health services. Good Samaritan Physician Services provides care without regard for an individual's health status or ability to pay.

Good Samaritan Physician Services provides medical care to patients in and around Lebanon County, Pennsylvania, without regard for the patient's ability to pay.

Balance Sheet Detail
LineBeginningEndChange
Assets
Accounts Receivable$2,557,983$3,710,933▲ $1,152,950
Land, Buildings, and Equipment, Net$98,534$229,548▲ $131,014
Intangible Assets$190,001$0▼ $190,001
Savings and Temporary Cash Investments-$80,746-
Prepaid Expenses and Deferred Charges$26,870$44,029▲ $17,159
Cash and Non-Interest-Bearing Accounts-$1,750-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Investments in Publicly Traded Securities-$0-
Inventories for Sale or Use-$0-
Total Assets$2,873,388$4,067,006▲ $1,193,618
Other Assets Total-$0-
Liabilities
Other Liabilities$17,389$7,746,639▲ $7,729,250
Accounts Payable and Accrued Expenses$3,947,897$1,310,317▼ $2,637,580
Deferred Revenue-$368-
Total Liabilities$3,965,286$9,057,324▲ $5,092,038
Net Assets / Fund Balance
Unrestricted Net Assets$-1,091,898$-4,990,318▼ $3,898,420
Total Net Assets Fund Balance$-1,091,898$-4,990,318▼ $3,898,420
Total Liabilities and Net Assets / Fund Balance$2,873,388$4,067,006▲ $1,193,618

Asset Categories

AssetBook ValueDepreciationBasis
Equipment$205,506$979,359$1,184,865
Leasehold Improvements$20,333$249,826$270,159
Other Land Buildings$3,709-$3,709
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseOtherTotal
Bryan PilkingtonPhysicianFT$548,838$124,034$672,872
David CozziPhysicianFT$539,038$112,810$584,558
Michael BeltzPhysicianFT$481,422$16,472$505,974
Kevin MosserCEO-wsh-$351,177$48,561$458,948
David DeysherPhysicianFT$414,966$43,692$458,658
Lisa DreibelbisSecretary--$132,838$132,838

Board Members and Trustees

NameTitle
Betty EicemanDirector
Roberto DyreyesDirector
Michael O'ConnorCFO-wsh
Robert SchadePhysician
Robert LongoPres. end 12/15
Robert RichardsTreas end 9/15

Highest Paid Contractors

ContractorServicesLocationCompensation
Shavkat Ruziev dba Qualimed LLCStaffing Physicians25 Ridge Avenue, Lebanon, PA 17042$702,425
Physician Assistant Surgical AssociationCT Surg Phys Asst CoPO Box 248, Myerstown, PA 17067$600,816
Lebanon Internal Medicine AssociatesServices, Equip Rent755 Norman Drive, Lebanon, PA 17042$512,438
West Cornwall Real EstateRent101 Fairview Circle, Lebanon, PA 17042$107,370
Wilson S Morris Jr & Leona EwingRent209 E High Street, Lebanon, PA 17042$104,994
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$27,027,557
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$-3,898,420

Audited Revenue Reconciliation

Revenue per Audited Statements
$27,027,557
Total Revenue per Audited Statements
$27,027,557
Total Revenue per Form 990
$27,027,557
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$19,019,112
Other Expenses$11,906,865
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$14,550,472$1,483,770-$16,034,242
Other Employee Benefits$1,110,090$113,200-$1,223,290
Payroll Taxes$801,644$81,746-$883,390
Pension Plan Contributions$796,925$81,265-$878,190
Occupancy$763,749$77,882-$841,631
Insurance$606,325$61,829-$668,154
All Other Expenses$420,577$42,888-$463,465
Fees for Services Management-$284,252-$284,252
Fees for Services Other$276,731$5,433-$282,164
Other Expenses$172,419$17,582-$190,001
Office Expenses$132,484$13,511-$145,995
Information Technology-$89,764-$89,764
Conferences and Meetings$62,079$6,330-$68,409
Depreciation Depletion$39,584$4,036-$43,620
Fees for Services Accounting-$12,200-$12,200
Fees for Services Legal-$12,190-$12,190
Travel$9,177$936-$10,113
Advertising$8,827--$8,827
Total Functional Expenses$27,810,324$3,115,653$0$30,925,977

Audited Expense Reconciliation

Line ItemAmount
Expenses per Audited Statements$30,925,977
Total Expenses per Audited Statements$30,925,977
Total Expenses per Form 990$30,925,977
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Notes Payable WellSpan Health$5,000,000
Accrued Payroll$1,588,365
AP Intercompany$1,057,532
Accrued Payroll w/h$100,742
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Backup withholding compliance
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder

Good Samaritan Health Services Foundation, a not for profit corporation, is the sole member of Good Samaritan Physician Services.

Form 990, Part VI, Line 7A: How Members or Shareholders Elect Governing Body

The Board of Directors of the Organization, not less than one nor more than six in number, shall be elected by the member at the annual meeting of the member of the Organization.

Form 990, Part VI, Line 7B: Describe Decisions of Governing Body Approval by Members or Shareholders

An affirmative action of the Member is required with regard to the following actions:a) Submission of actions required to be approved by the Memberb) Filling of vacancies in the Board of Directorsc) The adoption, amendment or repeal of the By-Laws.d) The amendment or repeal of any resolution of the Board.e) Action on matters committed by the By-Laws or resolution of the Board of Directors to another committee of the Board

Form 990, Part VI, Line 11B: Form 990 Review Process

Management provided an electronic copy of the form 990 to each voting member of the organization's governing body, prior to its filing with the IRS. The organization's finance management team provided a presentation to the Audit Committee on the organization's 990 return.

Form 990, Part VI, Line 12C: Explanation of Monitoring and Enforcement of Conflicts

Officers, directors, and key employees fill out a WellSpan Health Conflict of Interest Disclosure Statement questionnaire annually. The questionnaire is administered by the Internal Audit Department of WellSpan Health, the Parent Company.There shall be full disclosure by any Director having a business or personal interest or relationship which may be in conflict with the interests of the Corporation. After such disclosure the Director shall abide by the determination of the Board of Directors as to whether a conflict exists, the extent to which, if at all, the Director will be permitted to be present during the Board of Directors' discussion of the matter in which the Director may be interested, and whether the Director will be permitted to participate in such discussion and cast a vote in such matter.

Form 990, Part VI, Line 15A: Compensation Review & Approval Process - CEO, Top Management

see following explanation for 15b. Description for compensation and approval of CEO, executive director or top management is included here.

Form 990, Part VI, Line 15B: Compensation Review and Approval Process for Officers and Key Employees

The Compensation Committee of WellSpan Health is responsible for rewarding and reinforcing key executives for the achievement of annual and long-term performance objectives. The Compensation Committee shall consist of not more than six (6) persons, of whom two (2) shall be the Chairman and Vice Chairman of the Board of the Corporation, and the remaining members shall be such other persons as may be appointed by the Chairman of the Board of the Corporation, with the approval of the Board of Directors; provided, however, that the Compensation Committee shall not include any persons who are employed by the System. The Chairman of the Board of Gettysburg Hospital shall participate. The role of the Compensation Committee is to set the Executive Compensation Philosophy for the system and ensure adherence, evaluate performance and establish compensation for the WellSpan President, evaluate team performance of the executive team and establish awards, review and approve senior executive base salary ranges, and oversee employed physician compensation programs. The Committee will approve salary ranges for each executive position and review incumbent salaries annually. The Committee will be responsible for reviewing the President's salary each year, and if warranted, authorizing an adjustment to maintain competitiveness. The President will have the authority to make salary adjustments for subordinate positions. The Committee is responsible for approving and authorizing payment of the performance awards. The Committee will approve and authorize payment of the President's performance awards. Integrated Healthcare Strategies, Inc., based in Minneapolis Minnesota is the external consultant to the committee. This consultant focuses exclusively on executive and physician compensation in the health care industry. In summary, the executive and physician compensation review process consists of the following: 1) Cash compensation reviewed annually 2) Cash compensation reviewed by external consultant biennially 3) external total compensation (cash, incentives, benefits, perquisites) reviewed by external consultant periodically 4) Process is integrated with compensation analysis for other WellSpan positions 5) Committee decisions are documented in minutes maintained in Human Resources.

Form 990, Part VI, Line 19: Other Organization Documents Publicly Available

Governing documents, policies, and financial statements are available upon request.

Filing and Contact Details

Filer

Filer Name
Good Samaritan Physician Services
EIN
25-1832359
Phone
7178513055
Address
PO BOX 2767, YORK, PA 17405

Signing Officer

Name
Michael O'Connor
Title
CFO
Signed
2017-05-10
Discuss with paid preparer
No

Organization Details

Principal Officer
Kevin Mosser MD
Formed
2001
Legal Domicile
Pa
Voting Board Members
5
Independent Board Members
2
Employees
181

Preparer

Firm
WellSpan Health
Address
3350 WHITEFORD ROAD, YORK, PA 17402
Preparer
Jeffrey Schragg See Sch O
Phone
7038930600
Supplemental Narrative

Additional Explanations

Client Note 1

Client Note 1 - Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543

Signature Block - Paid Preparer Explanation

Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543

Part II Signature Block

Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543

Financial Statement Notes

Part X : FIN48 Footnote

In June 2006, the Financial Accounting Standards Board (FASB) issued Interpretation NO. 48, Accounting for Uncertainty in Income Taxes-an interpretation of FASB Statement NO. 109, Accounting for Income Taxes (FIN 48), which creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Under the requirements of FIN 48, tax-exempt organizations could now be required to record an obligation as the result of a tax position they have historically taken or various tax exposure items. Prior to FIN 48, the determination of when to record a liability for tax exposure was based on whether a liability was considered probable and reasonably estimable in accordance with SFAS No.5, Accounting for Contingencies. On July 1, 2007, the parent company, WellSpan Health, adopted FIN 48. WellSpan Health determined that it does not have any uncertain tax positions through June 30, 2016.

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IRS990/Form990PartVIISectionAGrp/PersonNm0Lisa Dreibelbis
IRS990/Form990PartVIISectionAGrp/PersonNm1Robert Longo
IRS990/Form990PartVIISectionAGrp/PersonNm2Robert Richards
IRS990/Form990PartVIISectionAGrp/PersonNm3Roberto Dyreyes
IRS990/Form990PartVIISectionAGrp/PersonNm4Betty Eiceman
IRS990/Form990PartVIISectionAGrp/PersonNm5Kevin Mosser
IRS990/Form990PartVIISectionAGrp/PersonNm6Michael O'Connor
IRS990/Form990PartVIISectionAGrp/PersonNm7Bryan Pilkington
IRS990/Form990PartVIISectionAGrp/PersonNm8David Cozzi
IRS990/Form990PartVIISectionAGrp/PersonNm9Michael Beltz
IRS990/Form990PartVIISectionAGrp/PersonNm10Robert Schade
IRS990/Form990PartVIISectionAGrp/PersonNm11David Deysher
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IRS990/Form990PartVIISectionAGrp/TitleTxt0Secretary
IRS990/Form990PartVIISectionAGrp/TitleTxt1Pres. end 12/15
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IRS990/MissionDesc0Good Samaritan Physician Services' mission is improving the health of patients and our communities as a multi-specialty group, built on a foundation of primary care and prevention, and coordinated within a comprehensive system of care to deliver exceptional and affordable health services. Good Samaritan Physician Services provides care without regard for an individual's health status or ability to pay.
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