2014-05-13T07:45:00-05:00 2013-06-30 990 2012-07-01 232367707 Lehigh Valley Hospital - Muhlenberg LEHI 4848840130 2100 Mack Blvd Allentown PA 181035622 Edward F O'Dea 6104027501 2014-05-13 2012 2015-11-30 17:44:51Z Ronald W Swinfard 2100 Mack Blvd Allentown PA 181035622 434105469 0 X www.lvhn.org X 1985 PA Our mission is to heal, comfort and care for the people of our community by providing advanced and compassionate health care of superior quality and value, supported by education and research. 11 6 1644 468 172310 171310 1341093 602666 249253279 251708770 14319106 5242882 3926409 3196308 268839887 260750626 0 0 0 0 99201941 101799296 0 0 621852 129976535 135049355 229178476 236848651 39661411 23901975 382307616 426702479 158757786 171395164 223549830 255307315 X Our mission is to heal, comfort and care for the people of our community by providing advanced and compassionate health care of superior quality and value, supported by education and research. 0 0 228946848 255237111 LVH-Muhlenberg is a non-profit corporation organized and existing under the laws of the Commonwealth of Pennsylvania, which owns and operates a general, acute patient care facility totaling approximately 882,000 square feet and operates 108 medical/surgical beds, 36 cardiac care beds, 10 universal open heart beds and 8 intensive care beds as of June 30, 2013. LVH-Muhlenberg offers a full range of inpatient and outpatient services, with the exception of obstetrics. LVH-Muhlenberg is a subsidiary of LVHN, which is LVH-Muhlenberg's sole corporate member.LVH-Muhlenberg is located on the northern edge of the City of Bethlehem. It is located at the intersection of Route 22 and Route 378 and is highly accessible from these highways with entrance/exit ramps located less than one-quarter mile from LVH-Muhlenberg. The local public transportation system, LANTA/METRO, has a bus stop located near the entrance of LVH-Muhlenberg.LVH-Muhlenberg provides a broad range of services, including the following:Acute CareAmbulatory SurgeryAnatomical PathologyBlood BankCancer ServicesCardiac CatheterizationAmbulatory SurgeryCardiac RehabilitationCardiovascular LabChest Pain ServiceClinical LaboratoryClinical Psychology ServicesCT ScannerDental ClinicDiagnostic Radioisotope FacilityDiagnostic Radiology DepartmentEchocardiography ServicesElectrocardiographyElectroencephalographyElectrophysiologyEmergency Department/Express ERGI LabHistopathologyHome HealthIndustrial RehabilitationInterventional RadiologyMagnetic Resonance ImagingMammographyNeuro Diagnostics LaboratoryNon-invasive Vascular LaboratoryNuclear MedicineOccupational HealthOccupational TherapyOpen Heart SurgeryOutpatient ServicesPain ManagementPediatric Ambulatory SurgeryPediatric Specialty ServicesPerioperative ServicesPeripheral Vascular SurgeryPharmacyPhysical TherapyPodiatry ServicesPost Anesthesia Care UnitPsychiatric Inpatient UnitPsychiatric Outpatient UnitPulmonary/Vascular RehabRadiation TherapyRenal DialysisRegional Heart CenterRehabilitation ServicesRespiratory TherapySleep LabSocial Service DepartmentSpeech TherapySports MedicineStress Test LaboratoryStroke CenterTele-Intensivist ServicesThoracic SurgeryValet ServicesVascular Medicine and SurgeryVolunteer Services DepartmentUltrasoundWound CareAccreditation, Approval and MembershipLVH-Muhlenberg is currently accredited by TJC under the most recent three-year accreditation effective July 2012. LVH-Muhlenberg's facilities and services are licensed by the Pennsylvania Department of Health and have been fully certified for Medicare and Medicaid reimbursement. LVH-Muhlenberg's licenses, accreditations, approvals and memberships are as follows:Licenses and AccreditationsThe Joint CommissionDepartment of Health, Commonwealth of PennsylvaniaDepartment of Public Welfare, Commonwealth of PennsylvaniaPathology Laboratory: Bureau of Laboratories, Department of Health, Commonwealth of Pennsylvania College of American Pathologists American Association of Blood Banks HCFA, CLIA CertificationPennsylvania State Board of PharmacyPA Department of Environmental ProtectionAmerican College of RadiologyApprovalsU.S. Department of Health & Human Services - Hospital certified for participation in Health Insurance for the Aged and Disabled Program (Medicare)Nuclear Regulatory Commission - Hospital utilization of radio-pharmaceuticals for diagnostic and therapeutic purposesMembershipsAmerican Hospital AssociationHospital Association of PennsylvaniaEastern Pennsylvania Emergency Medical Services CouncilAmerican Association of Medical CollegesCouncil of Teaching HospitalsAssociation for Hospital Medical EducationMagnet Status for Nursing ExcellenceIn August 2002, the American Nurses Credentialing Center (ANCC) granted Magnet designation to LVH and LVH-Muhlenberg, the first full-service hospitals in Pennsylvania to receive the recognition. Developed by the ANCC in 1994, the Magnet designation is the American Nurses Association's highest honor for excellence in nursing and recognizes both hospitals as national leaders in nursing education, research, patient satisfaction, quality care, job retention and the central role of nursing in the organization. Magnet designation is for a period of four years, at which time an organization must reapply. The reapplication process is intense, necessitating that hospitals demonstrate increasingly higher standards than previous applications. In 2006 and 2011, LVHN hospitals were redesignated as Magnet hospitals, continuing to demonstrate the required evidence of a practice environment in which professional nurses and interdisciplinary colleagues deliver the highest standards of quality care. Continued from 4(a)-Estimated Value of Free Care, Community Service, Charitable Contributions, and Professional and Community Education - Medicare Shortfall 10,939,412, Medical Assistance Shortfall 8,149,043, Uncompensated Charity Care 3,796,600, Bad Debt 4,221,395, Clinics Subsidy 857,656, CHAMPUS/Tricare Shortfall 64,604, Blue Cross Special Care & CHIP Shortfall 40,315, Real Estate Taxes Paid on Owned and Leased Property 294,406, Financial support to City of Bethlehem 45,000, Support to City of Bethlehem Health Bureau 24,025, Physical Examinations - Firefighters & HazMat Personnel 49,527, Value of Volunteer Assistance 825,831, Community Health & Health Studies Department in-kind, Division of Education - Office of Student Affairs in-kind, Helwig Diabetes Center Education & Outreach Programs in-kind, Pastoral Care 131,462, Patient Representative - Press, Ganey Survey 68,000, Foreign Language & Sign Language Interpreting Service in-kind, Community Health Education Publications 92,321, Patient Education Publications 128,169, Materials to Promote Health-Related Activities 101,743, Physician Referral & Health Information Line in-kind, Community Outreach in-kind, Voluntarism in-kind, Transportation for Discharged Patients 10,468, Infection Control Community Service in-kind, Dental Screenings and Free Procedures in-kind, Library Services to the Community in-kind, Stroke Center Community Education Programs in-kind, Sleep Disorders Center Community Education in-kind, Patient Care Services - Community Service (includes support groups and other programs) in-kind, HealthWorks Workplace Safety Activities in-kind, Medical Education 15,597,601, Nursing Education 1,529,374.Total - $46,966,952 228946848 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 0 0 1 83 0 1 1644 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 PA X X X The Organization 4848840130 2100 Mack Blvd Allentown PA 181035622 Gregory Brusko DO 1.00 60.00 X 0 423126 35977 Robert M Dickler 1.00 X 0 0 0 Robert J Dillman PhD 1.00 X 0 0 0 William H Lehr 1.00 X 0 0 0 William Mason 1.00 X 0 0 0 Michael Pistoria DO 1.00 60.00 X 0 251031 38243 Kathryn P Taylor 1.00 X 0 0 0 Martin K Till 1.00 X 0 0 0 Susan C Yee 1.00 X 0 0 0 Ronald W Swinfard MD 1.00 60.00 X X 0 1494611 35977 Jarret Patton MD 1.00 60.00 X 0 235871 36250 Thomas V Whalen 1.00 60.00 X 0 851266 31091 Edward F O'Dea 1.00 60.00 X 0 498723 36357 James A Rotherham 1.00 60.00 X 0 252275 44913 Kevin A Vrablik MD 60.00 X 181907 14929 32360 Basil Dolphin MD 60.00 X 203562 16178 33915 Carmine Pellosie DO 60.00 X 207310 14599 35771 Robert Murphy MD 60.00 X 658455 0 35977 Richard F Goy MD 60.00 X 163696 16541 32275 1414930 4069150 429106 29 0 1 0 Sodexho Inc & Affiliates PO Box 360170 Pittsburgh PA 152516170 Dietary Services 2647582 Crothall Healthcare 13028 Collection Center Drive Chicago IL 60693 Housekeeping Services 2091471 TGC LLC - Theodore N Giovanis PO Box 130 Highland MD 20777 Medicare Regulatory Consultant 636155 Suburban EMS PO Box 3339 Palmer PA 18042 Ambulance Services 247169 Burkavage Design Assoc LLC 1 West Broad Street Bethlehem PA 18018 Architectural Services 113956 5 602666 78070 602666 Outpatient Revenue 624100 137189709 137189709 Inpatient Revenue 624100 114519061 114519061 251708770 4152336 4152336 2541156 2159983 381173 381173 381173 172161366 171047135 23685 1114231 -23685 1090546 1090546 329070 124040 205030 205030 Health Network Labs 621500 1820691 1648381 172310 Misc. Income 900099 775082 775082 Lehigh Valley PHO 900003 14332 14332 2610105 260750626 255237111 172310 4738539 X 1647276 1647276 77966566 74508133 3162189 296244 2156206 1885313 247724 23169 14056108 13681062 349423 25623 5973140 5712531 237925 22684 5594 2773 2821 26900148 25632912 1267236 1009837 912322 97515 399856 389382 10474 539144 538146 998 5841748 5841748 278273 271926 6347 370791 370791 5662499 5662499 11677078 11675332 1746 1742880 1742880 MEDICAL SUPPLIES 26103169 26103169 BAD DEBTS EXPENSE 24489492 24489492 PURCHASED SERVCES 23048780 20899095 1895553 254132 OTHER SUPPLIES 1131093 1131093 5848973 5848973 236848651 228946848 7279951 621852 910 907 -258206 5286379 410703 327015 31108442 34700394 1676189 2253562 418456 551791 216782928 102791957 114537894 113990971 208579470 242166145 0 0 23072211 24428295 2761547 2997020 382307616 426702479 14511013 11697041 72511 44118 131600184 144780528 12574078 14873477 158757786 171395164 X 221478060 253166611 1517853 1582832 553917 557872 223549830 255307315 382307616 426702479 X 23901975 7786576 68934 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 728286 3955 38943 183 5098 765903 719801 1113 17225 -3257 13110 728286 658946 2800 65103 290 6758 719801 619853 50 44944 702 6224 657921 423512 18552 -11957 2233 -191979 619853 0.00000 0.73000 0.27000 0 0 9515406 9515406 142600928 62787819 79813109 4000289 2333195 1667094 52286793 37306569 14980224 8379512 364374 8015138 113990971 Investment-Lehigh Valley Physician Hospital Organization 7.3% 1096600 C Investment-Health Network Laboratories 14.69% 17120695 C Investment-LVHN Reciprocal Risk Retention Group 5000 C Investment-Westgate Professional Center, Inc.-100% 6206000 C 24428295 Due to Affiliates 345343 Pension Liability 4944165 Haz Mat Remediation Liability 612912 Insurance Liability 3635173 Security Deposits 2494 SWAP Liability 5333390 14873477 X Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment funds are used for continuing education, scholarships, research, clinical equipment, and nursing awards. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: In 2008, the Organization adopted Financial Accounting Standards Board (FASB) Interpretation No. 48 "Accounting for Uncertainty in Income Taxes" ("FIN 48"). FIN 48 has become part of ASC 740. FIN 48/ASC 740 establishes that the financial statement effects of a tax position taken or expected to be taken are to be recognized in the financial statements when it is more likely than not, based on technical merits, that the position will be sustained upon IRS examination. FIN 48 became effective for fiscal year 2008 for the Organization. The Organization has analyzed tax positions taken on federal income tax returns for all open tax years for the taxable entities and has determined that as of June 30, 2013, there are no uncertain tax positions taken or expected to be taken that would require recognition in the financial statements. The Organization has analyzed specific criteria regarding the exempt 501(c) 3 status for the tax exempt entities and has determined that as of June 30, 2013 the Organization is compliant with the qualifications for exemption from Federal income tax. Golf & Tennis 329070 329070 124040 329070 329070 124040 124040 205030 1 1 X 1 X 1 X 1 1 0 1 1 3796600 3796600 0.01790 16569900 8420857 8149043 0.03840 20366500 8420857 11945643 0.05630 650715 650715 0.00310 19059520 3461919 15597601 0.07340 1898425 1040769 857656 0.00400 21608660 4502688 17105972 0.08050 41975160 12923545 29051615 0.13680 1 4221395 3058256 65854481 56677961 9176520 X 1 1 1 LVHN Reciprocal Risk Retention Group Malpractice Insurance 0.16600 0.00000 0.00000 2 Health Network Laboratories LLC Laboratory Services 0.15000 0.00000 0.00000 3 Health Network Laboratories LP Laboratory Services 0.13770 0.00000 0.00000 4 Lehigh Valley Physician Hospital Organization Inc Health Care Services 0.05000 0.00000 0.00000 1 1 Lehigh Valley Hospital - Muhlenberg

2545 Schoenersville Road Bethlehem PA 18017

X X X X X Lehigh Valley Hospital - Muhlenberg 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X 1 1 X X X X X X 1 X 0 1 X 0 0 Part I, Line 6a: The Community Benefit Report is issued by Lehigh Valley Health Network - EIN 22-2458317, the parent company of Lehigh Valley Hospital - Muhlenberg. Part I, Line 7: The costing methodology is cost to charge ratio for programs with gross charges and direct costs for programs without gross charges. Part I, Line 7g: The clinics subsidy of $857,656 is the difference between the cost of services provided in the hospital clinics and the payments received for those services. The clinics at LVH-Muhlenberg include the dental clinic that is operated in conjunction with the dental residency program, and the outpatient mental health clinic (Base Service Unit) which provides evaluation, counseling and case management services to residents of Lehigh and Northampton counties. The Clinics Subsidy does not include the cost of any Uncompensated Charity Care as reported above. Clinic costs do include $27,694 of the wage and benefits expense of dental residents who provided care to clinic patients. This amount has been deducted from the total value of medical education,which is presented later in this document. Part I, L7 Col(f): The costing methodology for bad debt expense is the Medicare cost to charge ratio. The ratio of uninsured charges written off as charity was applied to total charges written off as bad debt to estimate the portion of bad debt that is attributed to patients under the hospital charity policy. Part III, Line 4: BAD DEBTS-In instances where the Organization believes a patient has the ability to pay for services and, after appropriate collection effort, payment is not made, the amount of services not paid is written-off, at charges, as bad debts. Amounts recorded as bad debts expense do not include charity. The amount of bad debts expense for the years ended June 30, 2013 and 2012, at charges, was $24,489,000 and $21,930,000 respectively, and is reported as Bad debts expense on the Combined Statements of Operations. Part III, Line 8: The source of the Medicare allowable costs relating to revenue received from Medicare is the FY '13 Medicare Cost Report. The revenue and expenses are both determined using Medicare principles. The hospital is providing the community a benefit in excess of Medicare payments. Part III, Line 9b: Financial Counseling staff will determine whether patients meet eligibility criteria for financial assistance. Accounts that do not meet the eligiblilty requirements will be referred to an external receivables follow up agency, and if not paid referred to a collection agency and subsequently transferred to bad debt status if the accounts remain unpaid. Lehigh Valley Hospital - Muhlenberg Part V, Section B, Line 3: The Council's community needs assessment focused on the health status of the Lehigh Valley (Lehigh and Northampton Counties). The CHNA approach incorporated best practice standards as recommended by the American Public Health Association and the Association for Community Health Improvement of the American Hospital Association. The Council employed several health assessment techniques that used both qualitative and quantitative data. The assessment began by using existing community health measures from, but not limited to, the Centers for Disease Control and Prevention (CDC), US Census Bureau, Dartmouth Atlas of Healthcare, Pennsylvania's Department of Health, and the University of Wisconsin's County Health Rankings. Community input was elicited through health opinion surveys, social reconnaissance with 84 key community members, and interviews with leading health experts. Findings from these efforts comprised a community health profile.Community dialogues were conducted using a Community-Based Participatory Research (CBPR) approach in two federally-designated medically underserved areas. The dialogues were facilitated by a national expert in CBPR in four 3-hour sessions with 170 community members in attendance. The findings from the Community Health Profile were discussed at length. These findings were strongly corroborated by the community members and stakeholders, who listed mental health, oral health, health disparities, racism, poverty, unhealthy lifestyles, poor education, and limited access to care as major barriers to health. Lehigh Valley Hospital - Muhlenberg Part V, Section B, Line 4: The Health Care Council of the Lehigh Valley includes representation from Lehigh Valley Health Network, Good Shepherd Rehabilitation Network, Sacred Heart HealthCare System, Saint Luke's University Hospital and Health Network, KidsPeace Psychiatric Hospital, and The Dorothy Rider Pool Health Care Trust. Lehigh Valley Hospital - Muhlenberg Part V, Section B, Line 5c: The Community Health Needs Assessment was mailed to key community leaders and was provided press coverage in the community newapaper and local television station. Lehigh Valley Hospital - Muhlenberg Part V, Section B, Line 16e: Collection activities are limited to hospital sending three statements requesting payment. The statements include information about the hospital's Financial Assistance Policy, soliciting the patients participation in the Financial Assistance Program. Part VI, Line 2: The Health Care Council of the Lehigh Valley (HCCLV) used quantitative and qualitative methods to identify both the major causes of death and illness, and the barriers to improving the health andwell-being of community residents. The HCCLV's approach has incorporated best practice standards recommended by the American Public Health Association and the Association for Community Health Improvement. These procedures included using multiple data sources and input from stakeholders including community organizations and community members. Quantitative data were collected from The Centers for Disease Control, US Census Bureau, Dartmouth Atlas of Healthcare, PennsylvaniaDepartment of Health's Vital Statistics and County Profiles, University of Wisconsin's County Health Rankings, National Cancer Institute State Cancer Profiles, Institute for People, community opinion surveys, and a Lehigh Valley disability survey. Qualitative data were collected using community focus groups and social reconnaissance, a process that intensely examined community dynamics with regards to health. Part VI, Line 3: Consistent with the mission and values of Lehigh Valley Health Network, it is the policy to provide medical care to all individuals without regard to their ability to pay for services. The Charity Care Policy which incorporates the LHVN Reduced Cost of Care program applies to uninsured and under-insured individuals who participate in the process to evaluate their ability to pay for LVHN services.Patients are identified by LVHN registration, Benefits and Verification, Customer Service, and Financial Counselors as being in financial need. The Financial Counselors help patients complete the application for Reduced Cost of Care. LVHN follows the Federal Poverty Guidelines to evaluate eligibility. Patients whose family income falls bellow 200% of the Federal Poverty guideline will have their entire balance forgiven for their qualifying services at a participating LVHN provider. Patients with a family income below 400% of the Federal Poverty guidelines will have a portion of their balance forgiven for qualifying services at a participating LVHN provider. Patients are evaluated for no cost or reduced premium insurance plans. The LVHN Financial Counselors will offer information to patients who are interested in seeing if they qualify for these programs offered by commercial insurance companies.Patients often express financial concern or need by contacting the LVHN Customer Service departments. The Customer Service representatives explain the programs available; Reduced Cost of Care, Medical Assistance, and a Reduced Patient responsibility for Self Pay patients. Patients will be referred to the Financial Counselors who work with patients to apply for Pennsylvania Medical Assistance. The Financial Counselors are located onsite. The PATHS representatives visit patients in their inpatient rooms, in the Cancer Center, and in the Emergency Department. In addition, LVHN advertises Financial Assistance in the local newspaper, on our public website and on the statements sent to our patients. Part VI, Line 4: The primary service area of LVH-Muhlenberg is comprised of seventeen (17) zip codes located primarily in eastern Lehigh County and western Northampton County. Most are within a ten-mile radius of LVH-Muhlenberg Based on U.S. Census Bureau data for the year 2010 census, the population of the primary service area was approximately 413,156 people. During fiscal year 2013, approximately 82% of the discharges from LVH-Muhlenberg were residents of the primary service area.The 2010 population of the secondary service area was approximately 294,855. During fiscal year 2013, approximately 11% of the discharges from LVH-Muhlenberg were residents of the secondary service area. Based on U.S. Census Bureau data, the current population of the combined primary and secondary LVH-Muhlenberg service areas is projected to increase approximately 5.4% (CAGR - .59%) by the year 2017, based on the extrapolation of the population CAGR from Census year 2000 - 2010. During fiscal year 2013, 7% of the discharges from LVH-Muhlenberg were residents outside the primary and secondary service areas. Part VI, Line 5: Lehigh Valley Hospital - Muhlenberg qualifies as an Institution of Purely Public Charity in Pennsylvania. This regulation is referred to as Act 55. To be considered a purely public charity, nonprofits must: (1) advance a charitable purpose; (2) donate or render gratuitously a substantial portion of its services; (3) benefit a substantial and indefinite class of persons who are legitimate subjects of charity; (4) relieve the government of some burden; and (5) operate entirely free from private profit motive.LVHM is required to reapply for this charitable status every five years and currently qualifies through February 28, 2016. 1 X X X X X 0 1 0 0 0 0 0 0 0 Gregory Brusko DO 0 399586 0 424 0 23116 0 0 0 35977 0 459103 0 0 Michael Pistoria DO 0 220247 0 0 0 30784 0 0 0 38243 0 289274 0 0 Ronald W Swinfard MD 0 920769 0 285000 0 288842 0 0 0 35977 0 1530588 0 0 Jarret Patton MD 0 221499 0 7150 0 7222 0 0 0 36250 0 272121 0 0 Thomas V Whalen 0 577654 0 135000 0 138612 0 0 0 31091 0 882357 0 0 Edward F O'Dea 0 399859 0 75000 0 23864 0 0 0 36357 0 535080 0 0 James A Rotherham 0 219648 0 34697 0 -2070 0 9686 0 35227 0 297188 0 0 Kevin A Vrablik MD 151855 13668 35093 1680 -5041 -419 0 0 29771 2589 211678 17518 0 0 Basil Dolphin MD 196143 16617 800 0 6619 -439 0 0 31541 2374 235103 18552 0 0 Carmine Pellosie DO 180430 14917 17514 0 9366 -318 0 0 33625 2146 240935 16745 0 0 Robert Murphy MD 428255 0 200165 0 30035 0 0 0 35977 0 694432 0 0 0 Richard F Goy MD 157872 17080 800 0 5024 -539 0 0 29370 2905 193066 19446 0 0 Part I, Line 4b Robert Murphy, MD 35,746 Basil Dolphin, MD 11,928 Carmine Pellosie, DO 12,396 Michael Pistoria, DO 12,910 Gregory Brusko, DO 23,478 Ronald W. Swinfard, MD 280,128 Jarret Patton, MD 13,351 Richard F. Goy, MD 9,704 James A. Rotherham 9,686 Thomas V. Whalen 126,966 Edward F. O'Dea 28,167 These amounts are accruals to a nonqualified supplemental executive retirement plan. A Lehigh County General Purpose Authority 911886539 52480GAY0 2008-06-04 18876416 construct, renovate & equip facilities 0 0 0 B Lehigh County General Purpose Authority 911886539 52480GBG8 2011-04-01 54648270 refund 9/12/96 & 4/21/99A issues; reissuance of 7/7/05 and 6/5/08 issues 0 0 0 C Lehigh County General Purpose Authority 911886539 52480GCB8 2012-12-12 75067274 construct, renovate & equip facilities; refund 10/17/01 and 5/21/03 issues 0 0 0 A 1248000 18932776 247575 464911 18220290 2010 0 0 1 1 B 2501910 54648270 54528750 119520 2011 1 0 1 1 C 75067274 58470215 896598 15700000 461 2012 1 1 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 1 1 Merrill Lynch & Goldman Sachs 20.000000000000 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 0 0 Kathryn P Taylor-Trustee Board Member of Capital Blue Cross - Trustee of LVHN/LVH/LVHM 23783267 Capital BlueCross is a third party insurer doing business with LVHN. 0 Susan C Yee-Trustee Partner in 94 Brodhead Associates - Trustee of LVHM/LVHN 118947 94 Brodhead Associates leases office space to LVHN at fair market rates. 0 X 848 Fair Market Value X 11 3932 Cost X IPADS 2 4800 Fair Market Value X Luggage 1 1610 Fair Market Value X Gift Cards/Tickets 39 6918 Fair Market Value X 32" Television 1 290 Fair Market Value X Pathway to Santa 45 17659 Cost 0 1 0 Form 990, Part VI, Section B, line 11 The process to review the 990's includes: Draft 1 of the returns is reviewed in detail with a focus on accuracy, completeness, and perspective by the LVHN Controller and the LVHN Corporate Legal Counsel. Draft 2 of the returns is reviewed by the Chief Financial Officer. All Compensation disclosures are reviewed by the Vice President - Human Resources. Draft 3 of the returns is reviewed together with the President & CEO, the Chief Financial Officer, the Controller and the Director-Tax. Final Returns are reviewed with LVHN Executive Committee of the Board of Trustees prior to their filing. Form 990, Part VI, Section B, line 12c Trustees, officers, management and members of the medical staff are required to complete the Conflict of Interest and Commitment questionnaire on an annual basis. Reported conflicts of interests are reported to the Lehigh Valley Health Network Board on an annual basis. The information is also shared with the Pennsylvania Department of Health during their survey process. Those affected within the organization and their immediate supervisors are responsible for ongoing compliance with the Policy both annually and in the interim between declaration periods where possible new conflict situations may arise. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee ("Committee") of the Board of Trustees of Lehigh Valley Health Network ("LVHN") is authorized to perform its functions for and on behalf of LVHN. The purpose of the Committee is to discharge the obligations of the Board of Trustees relating to the oversight and approval of Senior Management Council compensation and their ongoing professional development in accordance with applicable rules and regulations. Committee Organization: 1. The Committee shall be composed of at least four (4) members of the Board of Trustees, one of whom shall serve as Chair of the Committee. The Committee shall be composed entirely of Trustees who are entirely disinterested members of the Board. The Trustees will have no material relationship to LVHN and/or its Senior Management Council members that may limit their disinterestedness in this role, including that the Trustees (i) must not have any personal interest in the compensation arrangement, (ii) must not be related to or under the control of the person whose compensation is being evaluated, and (iii) must have no material business relationship with LVHN. If a proposed member of the Committee has identified a potential conflict of interest, the issue shall be reviewed by the disinterested members of the Audit Committee which shall report its findings to the Chair of the Executive Compensation Committee. Based on that review, the Chair and the Committee, absent the member with a potential conflict, will make the final determination as to the disinterestedness of the Trustee and the appropriateness of service. From time to time, there may be specific situations which pose a potential conflict of interest. In such instances, the Committee will make the appropriate determination. The Committee may also establish such other procedures as it may deem appropriate with respect to the disinterested status of its members, subject to Board approval. 2. The members and the Chair of the Committee shall be appointed each year by the Board of Trustees in accordance with its policies, and shall serve at the pleasure of the Board of Trustees for such term or terms as the Board of Trustees may determine. The Committee shall conduct its activities in conformity with the requirements of the LVHN By-Laws and the requirements of the Internal Revenue Code of 1986, and Regulations promulgated thereunder, together with any further obligations or requirements as directed by the Board. 3. Each Committee Member shall have the following qualifications: Ability to critically review performance and market practice data and apply relevant information fairly, while properly balancing the competing needs of LVHN's stakeholders. Ability to consider the objectives of linking compensation to performance and retaining high-performing personnel, all in the best interests of LVHN and in accordance with its charitable mission. An understanding of the market place regarding the attraction and retention of Senior Management Council employees and other key personnel. Functions, Duties and Authorities: The Committee on an annual basis shall: Assess the performance of the Chief Executive Officer, determine the Chief Executive Officer's compensation, discuss the appraisal with the CEO and report its determination generally to the full Board. Review the performance of all other members of the Senior Management Council and approve their compensation considering the recommendations of the Chief Executive Officer, and report its determinations generally to the full Board. Review the performance of disqualified persons and other individuals in key leadership positions as determined by the Committee. Review the succession plan and professional and career development of senior management in the organization. Review the compensation plan for selected physicians, including LVPG. Assure that any applicable compensation arrangement is reviewed by the Committee in accordance with all applicable rules and regulations, including Section 4958 of the Internal Revenue Code or its successor. In particular, the Committee intends that its determinations qualify for the "Rebuttable Presumption of Reasonableness" and thus it will ensure that: A compensation arrangement is approved in advance only by Committee members who do not have a conflict of interest with respect to the arrangement, It relies upon appropriate, independent comparability data prior to making its determination, and The basis for the determination is adequately documented concurrent with the Committee's approval. Adequate documentation requires (i) the terms of compensation, (ii) date of approval, (iii) members present, (iv) the source of comparability information and the data, (v) rationale for compensation levels that fall at the upper end of the comparability data, and (vi) any actions taken with respect to conflicts of interest of any member of the Committee. The documentation must be prepared by the later of the next meeting of the Committee or 60 days after final action and approved within a reasonable time thereafter. The Committee, with respect to the administration of the Retirement Plan shall: Appoint the Plan Administrator Delegate the day-to-day functions of Plan administration to the Plan Administrator. Specifically these delegated duties shall include: convening a pension administration committee, compliance with ERISA and IRS documentation and reporting requirements; oversight and management of the benefit claims appeal process; and preparation and distribution of disclosures to Plan participants, make recommendations to the LVHN Board regarding Retirement Plan design. Specific responsibilities shall include: reviewing and making recommendations on benefit structure, the Plan Document or the Trust Agreement; reviewing and recommending additions or deletions of organizational divisions covered by the Plan. The Committee shall also: Consider and make recommendations to the Board regarding the compensation philosophy for the Senior Management Council. Annually evaluate the performance and function of the Committee, including a review of its compliance with this Charter. Direct the establishment of a process that ensures compensation information is fully and fairly disclosed on the Form 990. Discharge such additional duties and responsibilities as the Board of Trustees may from time to time assign to it. Form 990, Part VI, Section C, line 18 Anothers Website - Guidestar. Upon request - hard copies with senior management and marketing. Form 990, Part VI, Section C, line 19 The Organization makes its financial statements available to the public through its Annual Report to the community. The Annual Report is distributed to all attendees at the Organizations annual public meeting. In addition, it is distributed via mail to members of the community. The Organizations governing documents and conflict of interest policy are not made available to the public. Other Fees Form 990, Part IX, line 11g Lab Test Fees: Program service expenses 13,791,119. Management and general expenses 0. Fundraising expenses 0. Total expenses 13,791,119. Physician Fees: Program service expenses 7,422,859. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,422,859. Other Fees: Program service expenses 4,418,934. Management and general expenses 1,267,236. Fundraising expenses 0. Total expenses 5,686,170. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in net realized gains/losses - restricted funds 68,934. Committee - oversight of audit Form 990, Part XI, Line 2c The Audit Committee of the Board of Trustees assumes responsibility for oversight of the audit and selection of an independent auditor. Written Policy - Joint Venture arrangements Form 990, Part VI, Line 16b Although the organization does not have a written policy with respect to evaluation of participation in joint venture arrangements, no joint venture is entered into without having had the transactional documents reviewed and evaluated by outside counsel and, if necessary, consultants and accountants to assure that the arrangement does not, in any manner, compromise the organization's exempt status and mission. Compensation of Officers, Directors, Trustees, Key Employees, etc. Form 990, Part VII, Line 1a Hours worked by these individuals reflect the combined hours spent as a Board Officer and an Employee of the organization. All compensation, benefits, etc. reported are for work as a member of senior management of the organization. The remainder of the officers, trustees, listed above are volunteers and receive no compensation. Lehigh Valley Health Network 1200 S Cedar Crest Blvd Allentown PA 18103 222458317 Parent Company PA 501(c)(3) 509(a)(3) III-FI N/A 0 Lehigh Valley Hospital 1200 S Cedar Crest Blvd Allentown PA 18103 231689692 Health Care Organization PA 501(c)(3) 170(b)(1) (A)(iii) Lehigh Valley Health Network 0 Lehigh Valley Physician Group 1200 S Cedar Crest Blvd Allentown PA 18103 232700908 Physician Practice Organization PA 501(c)(3) Line 9 Lehigh Valley Health Network 0 Muhlenberg Realty Corporation 1200 S Cedar Crest Blvd Allentown PA 18103 232245513 Real Estate Rentals PA 501(c)(3) 509(a)(3) III-FI Lehigh Valley Health Network 0 Lehigh Valley Health Network Realty Holding Co 1200 S Cedar Crest Blvd Allentown PA 18103 232586770 Real Estate Holding Co. PA 501(c)(2) N/A Lehigh Valley Health Network 0 LVHN Reciprocal Risk Retention Group 151 Meeting Street Ste 301 Charleston SC 29401 200037118 Insurance PA Lehigh Valley Health Network Related 2101084 0 0 Health Network Laboratories LLC 2024 Lehigh Street Allentown PA 18103 232932802 Laboratory Services PA Lehigh Valley Hospital Related 146250 0 0 Health Network Laboratories LP 2024 Lehigh Street Allentown PA 18103 232948774 Laboratory Services PA Lehigh Valley Hospital Related 2771236 19190413 0 0 Lehigh Magnetic Imaging Center 1230 S Cedar Crest Blvd Allentown PA 18103 232429077 Imaging Center PA N/A Lehigh Valley Health Services Inc 2100 Mack Blvd Allentown PA 181035622 232263665 Health Care Related Services PA N/A C 0 Lehigh Valley Anesthesia Services PC 2100 Mack Blvd Allentown PA 181035622 233096124 Anesthesia Services PA N/A C 0 Westgate Professional Center Inc 2100 Mack Blvd Allentown PA 181035622 231657333 Real Estate Rentals PA Lehigh Valley Hospital - Muhlenberg C 14152 5529984 1.00000 0 1 0 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 0 0 Westgate Professional Center Inc K 66000 Fair Market Value