2024-05-09T08:48:55-05:00 2023-06-30 222517863 WELLSPAN HEALTH 3350 WHITEFORD ROAD YORK PA 17402 990 2022-07-01 256450683 CHAMBERSBURG HOSPITAL WORKER'S COMPENSATION TRUST CHAM 7178513055 PO BOX 2767 YORK PA 175042767 LAURA BUCZKOWSKI EXECUTIVE VP & CFO 7178513055 2024-05-09 1 LAURA BUCZKOWSKI 999009999 0 DAVID RIZZUTO P01210563 7178513055 2024-05-09 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROXANNA GAPSTUR PO BOX 2767 YORK PA 175042767 329854 0 X WWW.WELLSPAN.ORG X 1993 PA WORKERS COMPENSATION BENEFITS FOR EMPLOYEES. 1 0 0 0 0 0 0 0 0 0 11295 9854 0 0 11295 9854 0 0 0 0 0 0 0 0 0 1319 2306 1319 2306 9976 7548 809715 817263 0 0 809715 817263 WORKERS COMPENSATION BENEFITS FOR EMPLOYEES. 0 0 PAYMENT OF MEDICAL/INDEMNITY EXPENSES ON BEHALF OF THE EMPLOYEES OF CHAMBERSBURG HOSPITAL, WAYNESBORO HOSPITAL, SUMMIT PHYSICIAN SERVICES AND CHAMBERSBURG HEALTH SERVICES, FOR CLAIMS ELIGIBLE UNDER THE PENNSYLVANIA WORKERS' COMPENSATION ACT. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 X DAVID P RIZZUTO 7178513055 3350 WHITEFORD ROAD YORK PA 174029081 X CHAMBERSBURG HOSPITAL EMPLOYER 0.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 27311 27311 302543 320000 -17457 -17457 -17457 9854 0 0 9854 TRUST ACCOUNT FEES 2306 2306 2306 0 2306 0 489715 817263 320000 0 809715 817263 0 0 X 809715 817263 809715 817263 809715 817263 7548 0 X 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 FOR THE WORKER'S COMPENSATION TRUST IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND/OR REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM, AND THEN FILED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE HELD BY THE CHAMBERSBURG HOSPITAL AND ARE AVAILABLE UPON WRITTEN REQUEST. APPLE HILL SURGICAL CENTER INC PO BOX 2767 YORK PA 174052767 222842253 SOLE GP IN LP. 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