2022-09-22T10:37:20-05:00 2021-12-31 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-01-01 237404857 LEBANON VALLEY BRETHREN HOME LEBA 7178385406 1200 GRUBB ROAD PALMYRA PA 17078 HENRY BRUBAKER VP FINANCE/CFO 7178385406 2022-09-15 1 HENRY BRUBAKER XXX-XX-XXXX KERRI N BOGDA CPA P00760402 7177404863 X 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LONDONDERRY VILLAGE JEFFREY SHIREMAN 1200 GRUBB ROAD PALMYRA PA 17078 27557235 0 X WWW.LONDONDERRYVILLAGE.ORG X 1974 PA CONTINUING CARE RETIREMENT COMMUNITY PROVIDING HOUSING, HEALTH CARE, AND RELATED SERVICES. 15 15 277 158 0 0 2117871 1710965 21825903 22556774 934032 1839567 267862 257816 25145668 26365122 249273 340138 0 0 14177312 13132861 0 0 229479 11002658 12587562 25429243 26060561 -283575 304561 76190307 78609610 54014287 55737054 22176020 22872556 X THE LEBANON VALLEY BRETHREN HOME, AN OUTREACH MINISTRY OF THE CHURCH OF THE BRETHREN, IS COMMITTED TO PROVIDING INDEPENDENT LIVING HOUSING, HIGH-QUALITY HEALTH CARE, AND SUPPORTIVE SERVICES FOR ELDERLY PERSONS IN AN ATTITUDE OF LOVE AND SERVANTHOOD. 0 0 22833633 340138 22556774 NURSING CARE - IN 2021, THE NURSING CENTER OF THE LEBANON VALLEY BRETHREN HOME (D/B/A LONDONDERRY VILLAGE) SUCCESSFULLY NAVIGATED ONE OF THE MOST CHALLENGING YEARS IN ITS 42-YEAR HISTORY. THE CORONAVIRUS PANDEMIC CONTINUED TO EXERT ITS INFLUENCE THROUGH SPORADIC CASES, MORE FREQUENT STAFF TESTING, AND A CONTINUING NEED TO USE SOCIAL DISTANCING AND INDOOR MASKING. IN THE EARLY MONTHS OF 2021, VIRTUALLY ALL OF THE NURSING RESIDENTS AGREED TO RECEIVE THEIR FIRST AND SECOND DOSES OF THE PFIZER VACCINE; A LITTLE MORE THAN HALF OF THE STAFF ALSO ROLLED UP THEIR SLEEVES FOR THE PFIZER VACCINE. SINCE THAT TIME, THE NURSING CENTER HAS CONTINUED TO EXPERIENCE OCCASIONAL POSITIVE CASES OF COVID-19, BUT THE INCIDENCE OF SERIOUS ILLNESS, HOSPITALIZATION, AND DEATH (FROM THE VIRUS) HAS PLUMMETED TO NEAR ZERO. THE PA DEPARTMENT OF HEALTH RESUMED ITS ANNUAL NURSING HOME INSPECTIONS IN 2021 AND THE NURSING CENTER WAS VISITED BY THE DOH IN APRIL OF 2021. IT WAS A VERY SUCCESSFUL SURVEY WITH ONLY TWO MINOR DEFICIENCIES, AND THE NURSING CENTER RETAINED ITS 5-STAR CMS QUALITY RATING. BY MID-YEAR IT BECAME CLEAR TO MANAGEMENT THAT LONDONDERRY VILLAGE WAS EXPERIENCING THE SAME CHALLENGES AS OUR COMPETITORS WITH RESPECT TO STAFFING; NURSING STAFF, IN PARTICULAR, WERE RESIGNING AT A MUCH HIGHER-THAN-NORMAL RATE, TYPICALLY BECAUSE OF STRESS AND BURN-OUT FROM THE PANDEMIC. NATIONALLY THIS TREND BECAME PART OF WHAT HAS SINCE BEEN CALLED "THE GREAT RESIGNATION", A LARGE SCALE VOLUNTARY REDUCTION IN THE WORK FORCE WHICH HAS CREATED INTENSE LABOR SHORTAGES IN MANY PARTS OF THE ECONOMY. THE LV NURSING CENTER WAS ALSO ADVERSELY AFFECTED LATE IN 2021 BY THE FEDERAL GOVERNMENT'S COVID-19 VACCINATION MANDATE, A REQUIREMENT THAT LED TO AT LEAST 15 STAFF RESIGNATIONS. IN VIEW OF THE STAFFING CONCERNS, MANAGEMENT AND THE BOARD OF TRUSTEES DECIDED TO TEMPORARILY CLOSE TWO OF OUR GREEN HOUSE NURSING UNITS, AND TO CONSOLIDATE THE REMAINING STAFF IN OUR FOUR OPEN GREEN HOUSES AND OUR LEFFLER CARE NURSING UNIT. OUR NURSING CENSUS FLOATED DOWN TO A MANAGEABLE 70 OR SO RESIDENTS, AND HAS BEEN IN THAT REGION EVER SINCE. OUR GOAL FOR 2022 WILL BE TO RECRUIT ADDITIONAL STAFF SO THAT WE CAN RE-OPEN OUR TWO GREEN HOUSES.PERSONAL CARE - IN THE PERSONAL CARE UNIT, THE PANDEMIC CONTINUED TO AFFECT EVERYDAY LIFE FOR THE RESIDENTS WHO RESIDE IN THAT AREA. RESIDENTS WERE PERMITTED TO RETURN TO THE MAIN DINING ROOM, BUT SOCIAL DISTANCING REGULATIONS REQUIRED THE TABLES AND SEATS TO BE SPREAD OUT IN A FASHION THAT WAS NOT CONDUCIVE TO TABLE CONVERSATIONS. FAMILY VISITATION WAS RE-OPENED IN PERSONAL CARE, BUT WAS STILL SUBJECT TO INDOOR MASKING RESTRICTIONS. THERE WAS A PRONOUNCED INCREASE IN ADMISSIONS TO PERSONAL CARE IN 2021, POSSIBLY A RELEASE OF THE PENT-UP DEMAND CREATED BY THE INITIAL LOCKDOWN PERIODS OF THE PANDEMIC; THE CENSUS ROSE TO ABOUT 36 RESIDENTS, ABOUT 15-20% HIGHER THAN NORMAL. OUR PERSONAL CARE ADMINISTRATOR RESIGNED IN 2021 AND WAS REPLACED BY LPN AMANDA ZIEGLER. INDEPENDENT LIVING - THE INDEPENDENT LIVING COMMUNITY LIKEWISE CONTINUED TO BE IMPACTED BY THE PANDEMIC, BUT IN MANY WAYS ALSO STARTED TO RECOVER FROM THE EARLIER RESTRICTIONS. THE CAFE' WAS RE-OPENED AT MID-YEAR, AT FIRST FOR TAKE-OUT ONLY, AND LATER FOR IN-PERSON DINING. LIKEWISE THE CONVENIENCE STORE AND FITNESS CENTERS RE-OPENED FOR RESIDENTS TO ENJOY AGAIN. GROUP ACTIVITIES STARTED TO RESUME, ALBEIT IN COVID-SAFE FASHIONS AS RESIDENTS (WEARING MASKS) GATHERED AGAIN FOR ACTIVITY PURPOSES, AND OUTDOOR ACTIVITIES PROLIFERATED. THE INDEPENDENT LIVING COMMUNITY CONTINUED TO EXPERIENCE STRONG DEMAND AS A STEADY STREAM OF NEW RESIDENTS MOVED ONTO THE CAMPUS. LONDONDERRY VILLAGE INDIRECTLY BENEFITTED FROM THE STRONG REAL ESTATE MARKET AS NEW RESIDENT PROSPECTS WERE ABLE TO EASILY SELL THEIR EXISTING HOMES, AND OFTEN FOR PRICES THAT WERE WELL ABOVE THEIR EXPECTATIONS. LONDONDERRY VILLAGE BEGAN MARKETING IN 2021 FOR ITS NEW INDEPENDENT LIVING EXPANSION, FOX RUN. PHASE 1 OF FOX RUN IS SLATED TO COMPRISE 7 SINGLE FAMILY HOMES, 2 DUPLEX TOWNHOMES, AND A TOTAL OF 24 ONE AND TWO BEDROOM 'HYBRID' APARTMENTS. BY THE END OF THE YEAR, WE HAD RECEIVED DEPOSITS ON 7 NEW FOX RUN ACCOMMODATIONS. HOWEVER, A START DATE FOR THE CONSTRUCTION WAS STILL BEING HELD UP BY DELAYS IN GETTING LAND DEVELOPMENT APPROVALS FROM THE COUNTY AND TOWNSHIP. WE ARE CERTAINLY HOPING TO GET THE FOX RUN PROJECT UNDERWAY IN 2022. 22833633 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 28 0 277 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X HENRY BRUBAKER VP OF FINANCE CFO 7178385406 1200 GRUBB ROAD PALMYRA PA 17078 CRAIG MOYER CHAIR 2.00 0.00 X X 0 0 0 JAMES SNELL VICE CHAIR 2.00 0.00 X X 0 0 0 DR DENNIS GINGRICH SECRETARY 2.00 0.00 X X 0 0 0 ROY MEYER TREASURER 1.00 0.00 X X 0 0 0 JAY BUFFENMYER DIRECTOR 1.00 0.00 X 0 0 0 DONALD BYLER DIRECTOR 1.00 0.00 X 0 0 0 WENDIE DI MATTEO-HOLSINGER DIRECTOR 1.00 0.00 X 0 0 0 REV RON LUDWICK DIRECTOR 1.00 0.00 X 0 0 0 SANDY PINTARCH DIRECTOR 1.00 0.00 X 0 0 0 GEORGE PORTER DIRECTOR 1.00 0.00 X 0 0 0 JETHRO DAVIS DIRECTOR 1.00 0.00 X 0 0 0 THOMAS SHENK DIRECTOR 1.00 0.00 X 0 0 0 RAYMOND FLAGG DIRECTOR 1.00 0.00 X 0 0 0 REV BELITA MITCHELL DIRECTOR 1.00 0.00 X 0 0 0 STEVEN TILLEY DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY SHIREMAN PRESIDENT/CEO 38.00 0.00 X 221790 0 55584 HENRY BRUBAKER VP FINANCE/CFO 38.00 0.00 X 139428 0 29319 JENNIFER GINDER VP HEALTH SERVICES 38.00 0.00 X 151039 0 14586 NICHOLE REICHARD CNA 67.00 0.00 X 124407 0 15932 DEBRA O'DONNELL RN NURSE MANAGER 45.00 0.00 X 121002 0 22304 B RENEE NEISWENDER DIRECTOR OF NURSING 38.00 0.00 X 110424 0 27285 LISA MORGANTHALL HR DIRECTOR 38.00 0.00 X 102493 0 29044 STEPHANIE FEGLEY ASST. DIRECTOR OF NURSING 38.00 0.00 X 101340 0 4174 1071923 0 198228 8 0 1 0 SHOPE'S GARDENS CONST INC 53 NORTH CHARLOTTE ST MANHEIM PA 17545 CONSTRUCTION SERVICES 1035400 ARTHUR FUNK & SONS INC 1405 BIRCH ROAD LEBANON PA 17042 CONSTRUCTION SERVICES 641278 AEGIS SCIENCES CORPORATION 515 GREAT CIRCLE ROAD NASHVILLE TN 37228 LAB TESTING SERVICES 531900 MORRISON LIVING 400 NORTH RIDGE ROAD ATLANTA GA 30350 MANAGEMENT CONTRACT/DINING SERVICES 477361 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY SERVICES 327633 12 66572 727881 916512 7686 1710965 NET RESIDENT SVC REV 623000 22285849 22285849 PA NURSING HOME ASSESSMT 623000 270925 270925 22556774 1365259 1365259 24130 29092 -4962 -4962 -4962 1537030 10366 1073088 0 463942 10366 474308 474308 25505 66572 32224 -6719 -6719 64258 57709 6549 6549 FOOD SERVICES 722210 123219 123219 BARBER SHOP 900099 92661 92661 MANAGED CARE PARTICIPATION FEE 900099 23436 23436 23632 23632 262948 26365122 22556774 0 2097383 340138 340138 611746 165625 446121 9367061 8296283 945957 124821 463008 428104 28132 6772 1987149 1664301 297355 25493 703897 581642 113316 8939 25417 25417 28390 28390 79244 79244 1857 1857 83450 83450 1886030 1854081 31949 182944 182944 135669 74122 61547 298591 48780 249811 2338163 2338163 40277 39867 410 129 129 548485 548485 4372102 4256115 100819 15168 272495 186009 86486 FOOD SERVICE COSTS 670870 670870 0 0 COVID EXPENSES 431680 431680 0 0 EQUIPMENT REPAIRS/RENTA 234091 221592 12499 0 COMMUNICATIONS 167824 83291 84533 0 789854 604485 137083 48286 26060561 22833633 2997449 229479 2044 1782 4065898 3380598 280599 294302 1217961 1137342 1125856 1164732 109624157 62137844 47748564 47486313 19415128 22123427 2334257 3021114 76190307 78609610 1514037 1234454 21077750 21002770 11734306 20979508 7650950 12037244 12520322 54014287 55737054 X 17829359 17990866 4346661 4881690 22176020 22872556 76190307 78609610 X 304561 777596 -385621 X X 0 1 X 1 0 X 1282679 2500467 1031376 2117871 1710965 8643358 21044182 22069827 22488786 21825903 22556774 109985472 22326861 24570294 23520162 23943774 24267739 118628830 35970 26373 89832 101937 11235 265347 0 35970 26373 89832 101937 11235 265347 118363483 379054 651854 992772 978527 1389389 4391596 379054 651854 992772 978527 1389389 4391596 451341 450669 496250 329720 352711 2080691 23157256 25672817 25009184 25252021 26009839 125101117 0.94610 0.95580 0.03510 0.02670 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2017 AMOUNT: $ 78,671. 2018 AMOUNT: $ 37,562. 2019 AMOUNT: $ 17,217. 2020 AMOUNT: $ 5,669. 2021 AMOUNT: $ 4,217. FOOD SERVICES - 2017 AMOUNT: $ 165,498. 2018 AMOUNT: $ 187,066. 2019 AMOUNT: $ 275,020. 2020 AMOUNT: $ 179,276. 2021 AMOUNT: $ 123,219. PR EVENT FEES - 2017 AMOUNT: $ 4,225. 2018 AMOUNT: $ 6,138. 2019 AMOUNT: $ 6,559. 2020 AMOUNT: $ 365. CONVENIENCE SHOP - 2017 AMOUNT: $ 43,531. 2018 AMOUNT: $ 50,860. 2019 AMOUNT: $ 58,642. 2020 AMOUNT: $ 64,503. 2021 AMOUNT: $ 64,258. BARBER SHOP - 2017 AMOUNT: $ 106,268. 2018 AMOUNT: $ 116,123. 2019 AMOUNT: $ 110,384. 2020 AMOUNT: $ 63,492. 2021 AMOUNT: $ 92,661. FUNDRAISING REVENUE - 2017 AMOUNT: $ 35,021. 2018 AMOUNT: $ 33,896. 2019 AMOUNT: $ 28,428. 2020 AMOUNT: $ 16,415. 2021 AMOUNT: $ 25,505. RESIDENT FACILITIES - 2017 AMOUNT: $ 18,127. 2018 AMOUNT: $ 19,024. 2021 AMOUNT: $ 19,415. MANAGED CARE PARTICIPATION FEE - 2021 AMOUNT: $ 23,436. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1857 1857 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO NATIONAL (LEADINGAGE) AND STATE (LEADINGAGE PA) ASSOCIATIONS. A PORTION OF THE STATE AND NATIONAL ORGANIZATION'S DUES ARE USED FOR LOBBYING PURPOSES. THE $1,857 REPORTED AS LOBBYING EXPENDITURES IS THE TOTAL OF LEADINGAGE'S DUES THAT WERE USED FOR LOBBYING PURPOSES BY NATIONAL LEADINGAGE AND LEADINGAGE PA. 2398435 247106 255089 105103 7593 2787934 2084901 136820 280602 97554 6334 2398435 1815339 12500 356020 92730 6228 2084901 1951085 17166 -109889 35715 7308 1815339 1759393 183 254814 51469 11836 1951085 1.00000 0.00000 0.00000 0 0 777519 777519 73166196 38062742 35103454 33183997 23450173 9733824 2496445 624929 1871516 47486313 REFUNDABLE FEES AND DEPOSITS 11997725 CHARITABLE GIFT ANNUITY OBLIGATIONS 28091 RESIDENT SECURITY DEPOSITS 494506 12520322 27025277 777596 -236466 541130 26484147 -119025 -119025 26365122 26328741 608318 608318 25720423 340138 340138 26060561 PART V, LINE 4: THE ENDOWMENT FUND IS INTENDED TO ASSIST NURSING, PERSONAL CARE AND INDEPENDENT LIVING RESIDENTS WHO ARE NO LONGER ABLE TO AFFORD THEIR OWN CARE. IT IS ALSO USED TO COVER THE DIFFERENCE BETWEEN GOVERNMENT PAYMENTS FOR CARE AND THE COST OF DELIVERING THE CARE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BENEVOLENT CARE -340,138. CHANGE IN VALUE OF SPLIT INTEREST 103,672. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -29,092. CONVENIENCE STORE PURCHASES -57,709. FUNDRAISING EXPENSES -32,224. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 29,092. CONVENIENCE STORE PURCHASES 57,709. FUNDRAISING EXPENSES 32,224. LOSS ON DEBT REFINANCING 418,455. CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENT 70,838. PART XII, LINE 4B - OTHER ADJUSTMENTS: BENEVOLENT CARE NETTED AGAINST REVENUE 340,138. CHICKEN BBQ/AUCTION 36427 16989 19438 9163 1350 6748 GOOD SAMARITAN DINNER 25525 23530 1995 1995 2500 168 3 30125 26053 4072 2640 2288 5372 92077 66572 25505 2640 13446 3850 12288 32224 -6719 1 BENEVOLENT CARE - PERSONAL CARE 7 182835 BENEVOLENT CARE - INDEPENDENT LIVING 9 114416 BENEVOLENT CARE - NURSING 1 42887 PART I, LINE 2: RESIDENTS WHO NEED FINANCIAL ASSISTANCE SUBMIT AN APPLICATION TO THE FINANCE OFFICE. FINANCIAL INFORMATION OF THE RESIDENT IS REVIEWED AND CONFIRMED. BASED UPON THE INFORMATION SUBMITTED, THE ADMINISTRATOR THEN MAKES A DECISION AS TO WHETHER FINANCIAL ASSISTANCE WILL BE PROVIDED. THE ADMINISTRATOR PROVIDES INFORMATION TO THE FINANCE COMMITTEE OF THE BOARD WITH RESPECT TO THE TOTAL ASSISTANCE THAT HAS BEEN AWARDED. THE RESIDENTS WHO RECEIVE THE BENEVOLENT CARE REMAIN ANONYMOUS TO THE FINANCE COMMITTEE. X X X X X 0 0 0 0 0 0 0 0 0 JEFFREY SHIREMAN PRESIDENT/CEO 221790 0 0 0 0 0 42147 0 13437 0 277374 0 0 0 HENRY BRUBAKER VP FINANCE/CFO 139428 0 0 0 0 0 15572 0 13747 0 168747 0 0 0 JENNIFER GINDER VP HEALTH SERVICES 151039 0 0 0 0 0 12565 0 2021 0 165625 0 0 0 A WEST CORNWALL TWP MUNICIPAL AUTHORITY 251640412 95235TAT0 2021-03-30 41260503 SEE PART VI 0 0 0 A 41260503 495063 1854708 19202492 19708240 1 0 0 0 A 0 0 1 1 1 1 0.02400 0.00000 0.02400 0 0 1 A 0 1 0 0 1 0 0 0 1 A 1 SCHEDULE K, PART I, LINE A, COLUMN F (A) THE CURRENT REFUNDING OF (1) THE AUTHORITY'S SENIOR LIVING FACILITY REVENUE BONDS (LEBANON VALLEY BRETHREN HOME PROJECT), SERIES OF 2006; (2) THE AUTHORITY'S REVENUE NOTE, (LEBANON VALLEY BRETHREN HOME PROJECT) SERIES B OF 2015, AS AMENDED AND SUPPLEMENTED; (3) THE AUTHORITY'S REVENUE NOTE, (LEBANON VALLEY BRETHREN HOME PROJECT) SERIES OF 2016, AS AMENDED AND SUPPLEMENTED AND (4) (AN OUTSTANDING CONSTRUCTION LOAN INCURRED BY THE CORPORATION ; (B) THE DESIGN, ACQUISITION, CONSTRUCTION, INSTALLATION AND EQUIPPING OF (1) ELEVEN TOWNHOMES AND COTTAGES; (2) TWENTY-FOUR HYBRID APARTMENTS; AND (3) A CLUBHOUSE CONTAINING SOCIAL ACTIVITIES SPACE AND A KITCHEN TO SERVE THE NEW RESIDENTIAL UNITS;AND (4) AN OUTSTANDING CONSTRUCTION LOAN; AND (C) THE PAYMENT OF CERTAIN OF THE COSTS AND EXPENSES INCURRED IN CONNECTION WITH THE ISSUANCE OF THE BONDS. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT IS SUBMITTED TO THE IRS, FORM 990 WILL BE REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD AT EITHER A REGULARLY SCHEDULED MEETING OR A SPECIALLY CALLED MEETING. THE REVIEW WILL BE CONDUCTED BY THE CEO AND THE CFO. THE REVIEW USUALLY CONSISTS OF LINE BY LINE ASSESSMENT AND DISCUSSION OF ALL RELEVANT SECTIONS AND LINE ITEMS. THE ENTIRE BOARD THEN RECEIVES A COPY OF THE FINAL 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS, REQUIRED ANNUALLY OF GOVERNING BODY MEMBERS, OFFICERS AND KEY EMPLOYEES, ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER. GOVERNING BODY MEMBERS AND KEY EMPLOYEES ARE EXPECTED TO DIVULGE ANY POTENTIAL CONFLICT OF INTEREST THEY MIGHT HAVE IN A GIVEN TRANSACTION, NOTIFY THE DECISION-MAKERS INVOLVED IN THAT TRANSACTION, AND REMOVE THEMSELVES FROM ANY DECISION-MAKING ROLE IN THE TRANSACTION. DETERMINATION OF CONFLICTS ON THE LEVEL OF THE GOVERNING BODY WILL BE MADE BY THE GOVERNING BODY. DETERMINATION OF CONFLICTS ON THE LEVEL OF KEY EMPLOYEE WILL BE DETERMINED BY THE CEO, OR IF THE CEO IS INVOLVED IN THE CONFLICT, THROUGH AN ANONYMOUS HOTLINE TO THE CORPORATE COMPLIANCE OFFICER, WHO HAS DIRECT REPORTING ACCESS TO THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS USES A CEO EVALUATION TOOL THAT IS COMPLETED BY BOARD MEMBERS AND GATHERS OTHER FEEDBACK RELATIVE TO THE PERFORMANCE OF THE CEO. THE COLLECTED INFORMATION IS CONSIDERED BY THE BOARD'S EXECUTIVE COMMITTEE. REPRESENTATIVES FROM THE EXECUTIVE COMMITTEE REVIEW THE RESULTS WITH THE CEO. THE LEADINGAGE PA ANNUAL WAGE SURVEY IS USED FOR DETERMINING COMPARABLE SALARIES FOR THE EXECUTIVE MANAGEMENT. SALARIES OF SIMILAR POSITIONS LOCATED IN CENTRAL PENNSYLVANIA ARE USED AS A FAIR VALUE COMPARISON. THE ENTIRE PROCESS ALONG WITH ANY COMPARABLE DATA USED IN SETTING COMPENSATION LEVELS IS RECORDED IN THE MINUTES OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. ADDITIONALLY, AUDITED FINANCIAL STATEMENTS ARE AVAILABLE WITH THE ANNUAL DISCLOSURE STATEMENT REQUIRED BY THE PENNSYLVANIA DEPARTMENT OF INSURANCE, ALSO AVAILABLE UPON REQUEST BY ANY MEMBER OF THE PUBLIC. THE DISCLOSURE STATEMENT IS ALSO MADE AVAILABLE TO ALL CURRENT LVBH COMMUNITY RESIDENTS IN THE COMMUNITY CENTER READING ROOM, AND TO ALL INCOMING RESIDENTIAL LIVING RESIDENTS AS THEY ARE MOVING INTO THE COMMUNITY. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 103,672. LOSS ON DEBT REFINANCING -418,455. CHANGE IN FAIR VALUE OF DERIVATIVE FINANCIAL INSTRUMENT -70,838. FORM 990, PART XI, LINE 2C: THE PROCESSES USED BY THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR.