Civic Intelligence

Good Samaritan Physician Services

990 • Fiscal year 2024 • EIN 25-1832359

Jul 01, 2023 to Jun 30, 2024 • Filed on May 08, 2025

PO Box 2767York, PA 17405-2767

(717) 851-3055

Siviq Scores

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

Liabilities / Assets

5th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2024 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2024

Liabilities / Revenue

5th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

2024 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2024

Net Margin

13th percentile

-17%

Higher net margin than 13% of similar nonprofits.

2024 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2024

Top Officer Pay

99th percentile

$3,123,984

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 15.0% of source-year revenue.

2024 filings • 501(c)3 • $10M-$25M nonprofits • Source year 2024

Asset Growth

Score unavailable

No value available

A valid growth rate could not be computed from the available filing history.

Annualized from 2023 to 2024

Revenue Growth

Score unavailable

No value available

A valid growth rate could not be computed from the available filing history.

Annualized from 2023 to 2024

Assets

Up

$3,063,984

Up $3,063,984 from 2023

Net Assets

Up

$3,063,984

Up $3,063,984 from 2023

Liabilities

Flat

$0

Flat from 2023

Revenue

Up

$20,792,133

Up $20,792,133 from 2023

Expenses

Up

$24,288,521

Up $24,288,521 from 2023

Net Income

Down

-$3,496,388

Down $3,496,388 from 2023

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

2024

Assets$3,063,984
Liabilities$0
Net Assets$3,063,984

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

2024

Revenue$20,792,133
Expenses$24,288,521
Net Income-$3,496,388
Jump To
Filing Snapshot
Filing Period
Jul 1, 2023 to Jun 30, 2024
Signed
May 8, 2025
Return Version
2023v6.0
Gross Receipts
$20,792,133
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.

Provide medical care to patients without regard for the patient's ability to pay.

Balance Sheet Detail
LineBeginningEndChange
Assets
Land, Buildings, and Equipment, Net$0$3,063,984▲ $3,063,984
Total Assets$0$3,063,984▲ $3,063,984
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Net Assets Without Donor Restrictions-$3,063,984-
Total Net Assets Fund Balance$0$3,063,984▲ $3,063,984
Total Liabilities and Net Assets / Fund Balance$0$3,063,984▲ $3,063,984

Asset Categories

AssetBook ValueDepreciationBasis
Buildings$3,014,339$2,488,044$5,502,383
Equipment$14,692$453,495$468,187
Leasehold Improvements$34,953$223,448$258,401
Compensation and Service Providers

Employees

NameTitleOtherTotal
Christopher Grant Psy DDirector$142,568$142,568

Board Members and Trustees

NameTitle
Moniqua AcostaChair
Roxanna Gapstur Phd RnPresident & CEO - Wellspan Health
Carrie WilsonVice Chair
Reyna BrittonVICE CHAIR (UNTIL DEC. '23)
Amanda Davis-buieDirector
Edward Tadajweski MdDirector
James StuccioDirector
Kim Kreider-umbleDirector
Robert FunkDirector
Robert HoffmanDirector
Roger ZimmermanDirector
Stephen LindseyDirector
Vincent GarciaDirector
Laura BuczkowskiExecutive VP & CFO - Wellspan Health
Faraaz YousufFormer Executive VP & COO
Ikechukwu Akunyili MdMedical Oncologist
Kevin Lorensten MdMedical Oncologist
Uzoma Nwakuche MdMedical Oncologist
Adnan Malik MdNon-invasive Cardiologist
Michael Vranian MdNon-invasive Cardiologist
Amy NelsonSecretary/sr VP & General Counsel
Michael SeimSr VP & Chief Quality Officer
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$20,789,333
Investment Income
$2,800
Other Revenue
$0
Change in Net Assets
$-3,496,388

Audited Revenue Reconciliation

Revenue per Audited Statements
$20,792,133
Revenue Not Reported on Financial Statements
$0
Revenue Not Reported on Form 990
$6,458,182
Total Revenue per Audited Statements
$27,250,315
Total Revenue per Form 990
$20,792,133
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$24,288,521
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$12,662,015$939,732-$13,601,747
Occupancy$227,506$27,134-$254,640
Insurance$101,810$7,608-$109,418
Depreciation Depletion$50,648$6,837-$57,485
Office Expenses$37,596$1,473-$39,069
Travel$23,094$1,839-$24,933
Conferences and Meetings$14,688$706-$15,394
All Other Expenses$10,960$662-$11,622
Other Expenses$9,995$89-$10,084
Information Technology$8,273$506-$8,779
Advertising$2,683$21-$2,704
Total Functional Expenses$23,301,889$986,632$0$24,288,521

Audited Expense Reconciliation

Line ItemAmount
Total Expenses per Form 990$24,288,521
Expenses per Audited Statements$24,186,331
Total Expenses per Audited Statements$24,186,331
Expenses Not Reported on Financial Statements$102,190
Other Expense Adjustments$102,190
Expenses Not Reported on Form 990$0
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
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
Yes
Compensation from other sources disclosed
No
CEO compensation reviewed
No
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, Section A, Line 4

Good samaritan physician services transferred its membership interest to wellspan medical group. Effective march 1, 2024 wellspan medical group leased certain physician specialists to good samaritan physician services.

Form 990, Part VI, Section A, Line 6

Wellspan medical group, a not-for-profit corporation, is the sole member of good samaritan physician services.

Form 990, Part VI, Section A, Line 7A

The primary purpose of the governance committee, as assigned by the wellspan health board of directors, is to develop and support the culture of high-functioning governance within the wellspan system, including through policies, nominations, competencies of directors, education, and self-evaluations. The governance committee shall consist of not less than five (5) nor more than seven (7) members. Neither the chair of the wellspan health board of directors nor persons who are not members of the wellspan health board of directors, may be appointed to the committee. Each governance committee member shall be nominated by the governance committee, and appointed by the wellspan health board of directors, for a term of one (1) year. Reappointment of a governance committee member for more than one (1) term is not automatic or presumed and shall be based on an individual performance evaluation of the governance committee member (as performed or overseen by the governance committee).

Form 990, Part VI, Section A, Line 7B

The following responsibilities are set forth as a guide for fulfilling the governance committee's purposes in such manner as the committee determines is appropriate: 1. Oversee the process of selecting and nominating directors and officers for each of the governing boards within the wellspan system, including ensuring that director nominees meet the qualifications required by the relevant board composition and competency grid and characteristics, bylaws, and board-approved policies and guidelines, as applicable, and establish other criteria that are desirable for directors; 2. Identify, evaluate and screen director candidates for each of the governing boards within the wellspan system (including incumbent directors for potential re-nomination), and nominate qualified individuals to the wellspan health board of directors for: (a) appointment or reappointment to regular terms, or (b) appointment to fill the remaining term of any governing board vacancies; 3. Review annually the size, composition and leadership of each of the governing boards within the wellspan system, including the wellspan health board of directors as a whole, its committees, and any advisory bodies, make a determination of whether the board, its committees and any advisory bodies reflect the appropriate balance of independence, sound judgment, business specialization, technical skills, diversity, fundraising and development ability, geographic and demographic representation, and other desired qualities, and recommend any appropriate changes to the wellspan health board of directors; 4. Coordinate and oversee a periodic self-evaluation of the role and performance of each of the governing boards within the wellspan system, including the wellspan health board of directors, its committees, and any advisory bodies, and each of their directors and officers; 5. Develop and recommend for approval by the wellspan health board of directors, review the effectiveness of, and recommend modifications as appropriate to, the organization's committee structure and organizational documents, including the articles of incorporation, bylaws, board-approved policies and guidelines, and committee charters; 6. The governance committee shall undertake the responsibility for board education and board retreat planning. In addition, the governance committee shall coordinate with management to develop and implement an effective orientation program for new directors, including assignment of experienced directors as appropriate mentors of new directors. 7. Review emerging corporate governance issues and best governance practices and make appropriate recommendations to the wellspan health board of directors; 8. Conduct a periodic self-evaluation of the performance of the committee, including its effectiveness and compliance with this charter, and recommend to the wellspan health board of directors modifications as appropriate; 9. The governance committee shall maintain minutes of governance committee meetings and records of its activities and shall report promptly to the wellspan health board of directors any action taken by the governance committee, any recommendations of the governance committee, and any other matters the governance committee deems appropriate or the wellspan health board of directors requests. 10. The governance committee shall undertake such other responsibilities as the wellspan health board of directors may delegate or assign to the governance committee from time to time. The governance committee shall be responsible to, and subject to the direction and control of, the wellspan health board of directors. The wellspan health board of directors shall be solely responsible for delineating the responsibilities of the governance committee. The governance committee shall perform only such functions and duties as shall from time to time be specifically delegated to the governance committee by the wellspan health board of directors. The governance committee does not have dele

Form 990, Part VI, Section B, Line 11B

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, Section B, Line 12C

Officers, directors, and key employees are required to complete a wellspan health "conflict of interest disclosure statement" questionnaire annually. The internal audit department of wellspan health administers the questionnaires. There shall be full disclosure by a 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. Additionally, all board members, employees, students, and volunteers of wellspan health and its related organizations must complete a "code of conduct" form to acknowledge that he or she understands that we all have an obligation to act in ways that will merit the trust, confidence, and respect of the community we serve, other health care providers, and all of those with whom we interact.

Form 990, Part VI, Section B, Line 15B

This organization does not directly compensate any employees. The following procedure is followed by our parent company and affiliates in setting compensation. The primary purpose of wellspan health compensation committee, as assigned by the wellspan health board of directors, is to review compensation packages offered and/or paid to senior system executives and practicing physicians employed within the system. The compensation committee shall monitor and evaluate the performance of the president and ceo of wellspan health and shall, at least annually, coordinate the in-person performance review of the president and ceo by the wellspan health board of directors. The compensation committee shall consist of 5-10 members of the wellspan health board of directors, including the chair and the vice chair. Each compensation committee member shall be nominated by the governance committee, and appointed by the wellspan health board of directors, for a term of one (1) year. Reappointment of a compensation committee member for more than one (1) term is not automatic or presumed and shall be based on an individual performance evaluation of the compensation committee member (as performed or overseen by the governance committee). The compensation committee shall be responsible to, and subject to the direction and control of, the wellspan health board of directors. The wellspan health board of directors shall be solely responsible for delineating the responsibilities of the compensation committee. The compensation committee shall perform only such functions and duties as shall from time to time be specifically delegated to the compensation committee by the wellspan health board of directors. The compensation committee does not have delegated authority, and therefore any actions and recommendations of the committee must be approved by the wellspan health board of directors before they are final and binding. In discharging its role, the compensation committee is empowered to inquire into any matter it considers appropriate to carry out its responsibilities, with access to all books, records, facilities, and personnel of the wellspan system. The following responsibilities are set forth as a guide for fulfilling the compensation committee's purposes in such manner as the committee determines is appropriate: 1. Set, periodically review and ensure compliance with the executive compensation philosophy for wellspan, in an effort to attract and retain high quality executives, while considering compensation offered to those in comparable positions in similar employment markets as well as the system's needs and financial resources. 2. Recommend approval of executive compensation program elements (incentives, supplemental benefits, etc.). 3. In conjunction with the wellspan health board of directors, evaluate performance and establish compensation for the president & ceo of wellspan health. 4. Evaluate executive team performance and establish awards. 5. Recommend approval of senior executive base salary ranges. 6. Align executive compensation with executive talent management and succession. 7. Oversee employed physician compensation program. 8. The compensation committee shall maintain minutes of compensation committee meetings and records of its activities, and shall report promptly to the wellspan health board of directors any action taken by the compensation committee, any recommendations of the compensation committee, and any other matters the compensation committee deems appropriate to the wellspan health board of directors requests. 9. The compensation committee shall undertake such other responsibilities as the wellspan health board of directors may delegate or assign to the compensation committee from time to time. The compensation committee also utilizes the services of sullivancotter, an independent, third-party health care compensation consultant, to align and structure workforce compensation and benefit strategies that support enterprise-wid

Form 990, Part VI, Section C, Line 19

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 17405-2767
Doing Business As
Wellspan Medical Services I

Signing Officer

Name
Laura Buczkowski
Title
Executive VP & CFO
Phone
7178513055
Signed
2025-05-08
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Roxanna Gapstur
Formed
2001
Legal Domicile
Pa
Voting Board Members
16
Independent Board Members
9
Employees
0
Volunteers
9

Preparer

Firm
Pwc US Tax Llp
Address
655 NEW YORK AVENUE NW - SUITE 1100, WASHINGTON, DC 20001
Preparer
Travis L Patton
Phone
2024141000
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 3

Effective march 1, 2024 good samaritan physician services resumed operations providing preventive services, primary care, and specialty services as well as began leasing certain physician specialists from a related organization, wellspan medical group.

Form 990, Part IX, Line 11G

Outside services: program service expenses 3,559,806. Management and general expenses 133,460. Fundraising expenses 0. Total expenses 3,693,266. Professional fees: program service expenses 3,420. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,420. Contracted wages: program service expenses 9,098,789. Management and general expenses 806,272. Fundraising expenses 0. Total expenses 9,905,061.

FORM 990, PART XI, LINE 9:

Transfers from affiliate 6,560,372.

Financial Statement Notes

PART X, LINE 2:

The company and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under section 501(c)(3) of the internal revenue code of 1986, as amended. Their related income is exempt from federal income tax under section 501(a). Some of the subsidiaries are taxable entities, and some of the income of the tax exempt entities is subject to taxation as unrelated business taxable income. The company and its subsidiaries file u.s. Federal income tax returns, and they also file in various state and foreign jurisdictions. The company accounts for uncertain tax positions in accordance with asc topic 740, income taxes. The company accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The company has determined that no significant unrecognized tax benefits or liabilities exist as of june 30, 2024 and 2023. Accounting for uncertainty in income taxes, asc topic 740-10 prescribes a comprehensive model for how an organization should measure, recognize, present and disclose in its financial statements uncertain tax positions that an organization has taken or expects to take on a tax return. The company is subject to routine audits by taxing jurisdictions. There are no current audits in progress. As of june 30, 2024, the company has no uncertain tax positions. A subsidiary of the company is classified as a reciprocal risk retention group (rrrg) formed under the federal liability risk retention act of 1986. Rrrg qualifies as an insurance company for federal income tax purposes. Rrrg is domiciled in vermont (vt) and operates within the states of pennsylvania (pa) and maryland (md). Vt, pa, and md do not impose a corporate income tax on insurance companies.

PART XI, LINE 2D - OTHER ADJUSTMENTS:

Transfers from affiliates 6,560,372. Bad debts -102,190.

PART XII, LINE 4B - OTHER ADJUSTMENTS:

BAD DEBTS 102,190.

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IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt40
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IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt2260032
IRS990/Form990PartVIISectionAGrp/PersonNm0ROXANNA GAPSTUR PHD RN
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IRS990/Form990PartVIISectionAGrp/PersonNm2MONIQUA ACOSTA
IRS990/Form990PartVIISectionAGrp/PersonNm3REYNA BRITTON
IRS990/Form990PartVIISectionAGrp/PersonNm4AMANDA DAVIS-BUIE
IRS990/Form990PartVIISectionAGrp/PersonNm5ROBERT FUNK
IRS990/Form990PartVIISectionAGrp/PersonNm6VINCENT GARCIA
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IRS990/Form990PartVIISectionAGrp/PersonNm9KIM KREIDER-UMBLE
IRS990/Form990PartVIISectionAGrp/PersonNm10STEPHEN LINDSEY
IRS990/Form990PartVIISectionAGrp/PersonNm11MICHAEL SEIM
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IRS990/Form990PartVIISectionAGrp/PersonNm13CARRIE WILSON
IRS990/Form990PartVIISectionAGrp/PersonNm14ROGER ZIMMERMAN
IRS990/Form990PartVIISectionAGrp/PersonNm15JAMES STUCCIO
IRS990/Form990PartVIISectionAGrp/PersonNm16AMY NELSON
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IRS990/Form990PartVIISectionAGrp/PersonNm18UZOMA NWAKUCHE MD
IRS990/Form990PartVIISectionAGrp/PersonNm19ADNAN MALIK MD
IRS990/Form990PartVIISectionAGrp/PersonNm20MICHAEL VRANIAN MD
IRS990/Form990PartVIISectionAGrp/PersonNm21KEVIN LORENSTEN MD
IRS990/Form990PartVIISectionAGrp/PersonNm22FARAAZ YOUSUF
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IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt90
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IRS990/Form990PartVIISectionAGrp/TitleTxt0PRESIDENT & CEO - WELLSPAN HEALTH
IRS990/Form990PartVIISectionAGrp/TitleTxt1EXECUTIVE VP & CFO - WELLSPAN HEALTH
IRS990/Form990PartVIISectionAGrp/TitleTxt2CHAIR
IRS990/Form990PartVIISectionAGrp/TitleTxt3VICE CHAIR (UNTIL DEC. '23)
IRS990/Form990PartVIISectionAGrp/TitleTxt4DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt5DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt6DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt7DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt8DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt9DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt10DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt11SR VP & CHIEF QUALITY OFFICER
IRS990/Form990PartVIISectionAGrp/TitleTxt12DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt13VICE CHAIR
IRS990/Form990PartVIISectionAGrp/TitleTxt14DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt15DIRECTOR
IRS990/Form990PartVIISectionAGrp/TitleTxt16SECRETARY/SR VP & GENERAL COUNSEL
IRS990/Form990PartVIISectionAGrp/TitleTxt17MEDICAL ONCOLOGIST
IRS990/Form990PartVIISectionAGrp/TitleTxt18MEDICAL ONCOLOGIST
IRS990/Form990PartVIISectionAGrp/TitleTxt19NON-INVASIVE CARDIOLOGIST
IRS990/Form990PartVIISectionAGrp/TitleTxt20NON-INVASIVE CARDIOLOGIST
IRS990/Form990PartVIISectionAGrp/TitleTxt21MEDICAL ONCOLOGIST
IRS990/Form990PartVIISectionAGrp/TitleTxt22FORMER EXECUTIVE VP & COO
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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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