2011-05-12T06:53:04-05:00 2010-06-30 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 990 2009-07-01 231370484 Ephrata Community Hospital EPHR 7177330311 169 Martin Ave PO Box 1002 Ephrata PA 175221002 John A Holmes 7177330311 2011-05-10 1 Julius Green CPA 2159720701 2009 2016-02-24 21:20:13Z John Porter 169 Martin Ave PO Box 1002 Ephrata PA 175221002 181570590 0 X www.ephratahospital.org X 1940 PA HOSPITAL PROVIDING PREVENTIVE, PRIMARY, ACUTE CARE, DIAGNOSTIC AND REHABILITATIVE SERVICES. 21 21 2112 250 1378584 344084 1222012 831866 166796129 172158472 34748 484789 2278346 1481201 170331235 174956328 38800 6736523 0 85511730 89168575 0 420482 78631939 79619153 164182469 175524251 6148766 -567923 131933826 131353186 66238643 70969210 65695183 60383976 The mission of Ephrata Community Hospital:1) To assure community access to health care services that are high in quality, compassionate and cost-effective.2) To partner with employees, physicians, volunteers, and other health care organizations to meet the health care needs of the communities we serve.3) To combine advanced medical technology with professional, personalized care. 0 0 162561082 6736523 171514769 Ephrata Community Hospital is an acute care hospital providing care for residents of northern Lancaster County and surrounding communities. For the fiscal year that ended June 30, 2010, program services included 8,270 inpatient acute, sub-acute, behavioral health, acute rehab and newborn admissions, for a total of 31,387 patient bed days.Additionally, outpatient services included 441,629 patient visits. These services included imaging studies (x-ray, ultrasound, MRI, CT, Mammography), lab testing, physical, occupational and speech therapy, non-invasive cardiology procedures including echocardiograms and EKG's, behavioral health counseling, radiation and medical oncology, emergency department visits, prenatal care through our Healthy Beginnings Plus program, sleep testing, home care and additional therapeutic and diagnostic services. Beyond these services, the hospital provides a range of community wellness and health education programs. In the fiscal year that ended June 30, 2010, there were 150 programs offered, serving 52,291 people in our community. These programs include health screenings, diabetes education, and weight management, smoking cessation, instruction in CPR and first aid, support groups, immunizations, community health fairs and health education newsletters and television programming. Many of these programs are offered for free or at a minimal cost to participants.Because the Hospital's mission is to provide care to all, regardless of ability to pay, we work with patients who have difficulty paying their bills. During the fiscal year ending June 30, 2010, the Patient Financial Services took an active role in promoting the ECH Cares program that assists needy patients, with Ephrata ultimately providing $5,002,000 in charity care. 162561082 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 216 0 1 2112 1 1 1 0 0 0 0 1 0 0 0 0 21 21 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 0 PA X John A Holmes CFO 7177386753 169 Martin Ave PO Box 1002 Ephrata PA 175221002 Dean A Stoesz 2.00 X X 0 0 0 R Fred Groff III 1.00 X X 0 0 0 E Richard Young Esq 1.00 X X 0 0 0 Linda L Kling 1.00 X X 0 0 0 Linda H Weaver 1.00 X X 0 0 0 Aaron L Groff Jr 1.00 X X 0 0 0 Edward G Camerino MD 1.00 X 0 0 0 Charles M Evans MD 1.00 X 0 0 0 William C Funk DMD 1.00 X 0 0 0 Robert A Garvin DO 1.00 X 0 0 0 Michael P Kane Esq 1.00 X 0 0 0 Richard C Lewis 1.00 X 0 0 0 Ronald L Miller CPA 1.00 X 0 0 0 C David Noll DO 1.00 X 0 0 0 Gilbert L Sager 1.00 X 0 0 0 Bonnie R Sharp 1.00 X 0 0 0 Earl D Shirk 1.00 X 0 0 0 Chris M Theodoran DO 1.00 X 0 0 0 Kent C Trachte PhD 1.00 X 0 0 0 Dale Whitebloom DO 1.00 X 0 0 0 Paul M Zimmerman Jr 1.00 X 0 0 0 John M Porter Jr 40.00 X 503776 0 42150 VINCENT D GLIELMI DO 40.00 X 233390 0 39951 Robert F Graupensberger 40.00 X 223282 0 39253 John A Holmes 40.00 X 211506 0 35188 Peter C Cote MD 40.00 X 465537 0 42150 Wilfred A Layne MD 40.00 X 432667 0 37250 William Loretan DO 40.00 X 375566 0 37250 Steven W Zebert DO 40.00 X 331987 0 42150 Il Jun Chon MD 40.00 X 298987 0 37359 3076698 0 352701 54 0 1 0 Navin Haffty and Associates LLC 200 Cordwainer Drive Norvell MA 02061 Computer Consulting/Implementation 337832 Barley Synder LLC 126 East King Street Lancaster PA 17602 Legal Services 221291 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 Accounting/Tax Services 142449 Steve's Painting 49 East Summit Drive Stevens PA 17578 Painting 134541 Wilmington Professional Associates 307 Ruther Drive Newark DE 19711 Billing Services 134195 5 34075 131322 666469 831866 Net patient service re 621400 171095645 171095645 Lab Courier Revenue 621500 721595 721595 Medical Equipment 541900 341232 341232 172158472 343369 343369 1337461 1555965 -218504 -218504 51498 -270002 4917126 68355 4844061 73065 68355 141420 141420 352126 34075 164449 187677 187677 81662 49787 31875 31875 Cafeteria Revenue 722210 583608 583608 COMMUNITY HEALTH EDUCA 611710 348913 348913 Tobacco/Champus Revenu 900099 166285 166285 381347 70211 264259 46877 1480153 174956328 171514769 1378584 1231109 6736523 6736523 1328496 535876 792620 64888425 60951069 3797863 139493 3869565 3620387 240888 8290 14485529 13508269 946461 30799 4596560 4297478 288149 10933 262830 262830 155186 155186 97026 97026 15195606 12975258 2113672 106676 365105 359530 88 5487 34628797 34521319 87897 19581 5583743 5308241 275502 401918 375972 25786 160 147776 101876 45090 810 1631318 1631318 7424241 7424241 1609910 1609910 UBI TAX 27762 27762 Bad Debt Expense 9820562 9820562 Repairs & Maintenance 1039529 1037767 1762 Licenses & Dues 387276 274995 111476 805 Professional Developmen 289389 289348 41 551179 325345 128386 97448 175524251 162561082 12542687 420482 5466 4662 9920665 11091495 158473 87363 22327114 20794502 6079955 5768758 887175 2151518 140328652 73562048 69001778 66766604 13258668 14389275 918948 900069 9375584 9398940 131933826 131353186 14887797 16279412 157594 144102 36435000 33210000 564404 320000 14193848 21015696 66238643 70969210 X 64248711 59341319 904837 445901 541635 596756 65695183 60383976 131933826 131353186 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 97026 97026 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Lobbying activities consisted of phone calls and meetings by two independent contractors to lobby on behalf of the Hospital at both the federal and state level for healthcare issues, grant money, and appropriations money. The lobbying firms were paid $96,000 for this service. The Hospital also pays dues to the Hospital & Healthcare Association of Pennsylvania ("HAP"). The portion of dues used by HAP for lobbying purposes was $1,026. 4800601 4800601 55628223 22235165 33393058 4797598 2649057 2148541 70666440 46897574 23768866 4435790 1780252 2655538 66766604 Other Assets 525273 Beneficial Interest in Perpetual Trusts 596756 Due from Affiliate 8276911 9398940 Charitable Gift Annuities 111244 Estimated third-party payor settlements & advances 1300341 PENSION LIABILITY 16951783 Cash Flow Derivative Financial Instrument 1573758 Deferred Compensation 1074798 Other Liabilities 3772 21015696 174956328 175524251 -567923 343603 -5086887 -4743284 -5311207 171805733 343603 -5231439 -4887836 176693569 -1737241 -1737241 174956328 177124116 1737241 1737241 175386875 137376 137376 175524251 Part X: Description of Uncertain Tax Positions Under FIN 48: The Hospital accounts for uncertainty in income taxes recognized in its financial statements using a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. Management determined there were no tax uncertainties that met the recognition threshold in 2010 and 2009. Part XI, Line 8 - Other Adjustments: Pension liability adjustment: -4688053. Unrealized loss on derivative financial instrument: -461131. Valuation gain on beneficial interest in perpetual trusts: 55121. Prior Period Adjustment: 7176. Part XII, Line 2d - Other Adjustments: PENSION LIABILITY ADJUSTMENT: -4688053. UNREALIZED LOSS ON DERIVATIVE FINANCIAL INSTRUMENT: -461131. VALUATION GAIN ON BENEFICIAL INTEREST IN PERPETUAL TRUSTS: 55121. Grant Repayment: -137376. Part XII, Line 4b - Other Adjustments: Rental Expense: -1523005. Special Events Expense: -164449. Gift Shop Expenses: -49787. Part XIII, Line 2d - Other Adjustments: Rental expense: 1523005. Special Events Expense: 164449. Gift Shop Expenses: 49787. Part XIII, Line 4b - Other Adjustments: Grant Repayment: 137376. Starlight Gala 224085 20475 203610 25321 26848 11250 43398 Golf Outing 162116 13600 148516 3400 15896 16864 4000 17472 386201 34075 352126 3400 41217 43712 15250 60870 164449 187677 1 1 1 X 1 X 1 1 0 1 1 1492600 0 1492600 0.00900 11840676 5543436 6297240 0.03790 407208 209191 198017 0.00120 13740484 5752627 7987857 0.04810 140000 0 140000 0.00080 131000 0 131000 0.00080 2368785 1583000 785785 0.00470 275000 118000 157000 0.00090 2914785 1701000 1213785 0.00720 16655269 7453627 9201642 0.05530 13642 6511 7131 0.00000 13642 6511 7131 1 3567352 2140411 35335776 45860740 -10524964 X 1 1 Crossroads Surgery Center Surgery Center 0.67000 0.00000 0.33000 Ephrata Community Hospital

169 Martin Avenue Ephrata PA 17522

X X X Crossroads Surgery Center

4150 Barrett Blvd Ephrata PA 17522

Ambulatory Surgery Center Part I, Line 7: Costing methodology used to calculate the amounts reported in the table: A patient cost to charge ratio was utilized for lines a, b and c using Worksheet 2 for Form 990. Actual specific cost identification was utilized for lines e, f, g and i. Part I, Line 7f: The amount of bad debt expense included on Form 990, Part IX, line 25, but subtracted for purposes of calculating the percentage in this column is $9,584,000. Part III, Line 4: Costing methodology used to determine the amount reported in Part III, lines 2 and 3: Bad debt expense amounts calculated using the patient cost to charge ratio (worksheet 2 of Form 990). Other bad debt amounts are not included in community benefits.How the organization accounts for discounts and payments on patient accounts in determining bad debt expense: Bad debt expense is driven by the bad debt allowance, which is based upon historical bad debt write-off activity, less payments made on accounts after they have been written off.Method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information had been available to make a determination of their eligibility: Represents 60% of bad debt written off, at cost. Rationale for including bad debt amounts eligible under the organization's charity care policy is from utilization of independent presumptive charity care scoring on accounts sent to bad debts for the months of July through September 2010 to come to a percentage to apply to fiscal year 2010.Footnote to the organization's financial statements that describes bad debt expense: Accounts receivable, patients and other receivables are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. The allowance for doubtful collections is estimated based upon a periodic review of the accounts receivable aging, payor classifications, and application of historical write-off percentages. Part III, Line 8: Costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6: Medicare cost report, less expense amounts specifically attributable to line 7g. These expense amounts are calculated using actual cost to charge ratios for the departments involved.The extent to which any shortfall reported in Part III, line 7 should be treated as a community benefit: As a Medicare contractor, we have no say on the amount of reimbursement, yet for all practical purposes need to contract with Medicare to remain viable. So, to the extent that we have expenses in excess of revenue, it should be treated as a benefit to the community. Part III, Line 9b: Collection practices set forth in the policy that apply to patients the organization knows qualify for charity care or financial assistance: Patients who qualify for charity care or financial assistance are not subject to debt collection as the accounts are pulled out prior to being sent to collections or put on hold pending completion of the application process. Accounts will be pulled out of collections if a charity care application is subsequently completed. Part V: Other health care facilities: 8 Center for Health diagnostic centers; 1 cancer center; 2 sleep centers; Home care services; 3 durable medical equipment stores; 5 other medical clinics/diagnostic sites. Part VI, line 8: While community benefit reports are prepared, none are required to be filed with the Commonwealth of Pennsylvania. Part VI, Line 2: A formal community needs assessment has not yet been conducted, but planning efforts are underway for such an assessment by 2012. Part VI, Line 3: All registration sites have both signs concerning the hospital's charity care available, as well as charity care brochures with applications; customer service also has charity care brochures with applications. All patient bills solicit patients requiring assistance to contact the hospital at the number provided. The organization's website has the charity care policy with a down-loadable application. All scheduled procedures are solicited as part of pre-registration regarding both the hospital's charity care program as well as the hospital's advocate for Medical Assistance (MA); MA advocacy also referred for all inpatient and short-stay patients, plus certain (significant) emergency room visits. Part VI, Line 4: The mission of Ephrata Community Hospital is to meet the primary and acute care needs, as well as the need for diagnostic and rehabilitative services within the communities that we serve. Independently developed to serve local needs, the primary purpose of the hospital is to assure community access to quality, compassionate and cost-efficient healthcare. With a qualified and diversified medical staff, Ephrata Community Hospital cares for the needs of patients of all ages with courtesy and professional expertise.Ephrata Community Hospital serves the northern Lancaster County community as well as parts of southern Berks County, Eastern Lebanon County and western Chester County. Many of the patients using services offered by Ephrata Community Hospital reside in the following zip codes: 17039 KLEINFELTERSVILLE, PA17501 AKRON, PA17505 BIRD IN HAND, PA17506 BLUE BALL, PA17507 BOWMANSVILLE, PA17508 BROWNSTOWN, PA17517 DENVER, PA17519 EAST EARL, PA17522 EPHRATA, PA17528 GOODVILLE, PA17529 GORDONVILLE, PA17533 HOPELAND, PA17540 LEOLA, PA17543 LITITZ, PA17557 NEW HOLLAND, PA17564 PENRYN, PA17567 REAMSTOWN, PA17569 REINHOLDS, PA17578 STEVENS, PA17580 TALMAGE, PA17581 TERRE HILL, PA17585 WITMER, PA19501 ADAMSTOWN, PAThe community served includes the boroughs of Ephrata, New Holland, Denver, Adamstown and Lititz as well as surrounding townships. Although predominantly suburban, the region served also includes a significant portion of Lancaster County's farming community. Ephrata Community Hospital serves this increasingly diverse population through a main facility in Ephrata Borough and freestanding outpatient centers in Stevens, Ephrata, New Holland, Leola, Lititz, Rothsville, Brownstown and Adamstown. Additionally, the hospital operates a freestanding Cancer Center and Diagnostic Center in Ephrata.Ephrata Community Hospital is the only nonprofit inpatient facility in northern Lancaster County. Heart of Lancaster Regional Medical Center, a for-profit facility, is located in Lititz, 9 miles to the West. Lancaster General Hospital is located in the City of Lancaster 13 miles south of Ephrata, and the Reading Hospital Medical Center is 18 miles north of Ephrata. The Pennsylvania Department of Health's Lancaster Health Profile for 2009 indicates that 11.7% of the County's population is eligible for Medical Assistance. Considering the current economic downturn and increases in unemployment and underemployment in this region, Ephrata Community Hospital believes that an even greater percentage of individuals are now eligible for Medical Assistance. Further, the Per Capita personal income decreased in our service area. Also reflective of the economic downturn, recent Pennsylvania Workforce Information reports the seasonally adjusted unemployment rate for Lancaster County at 7.3%. Higher unemployment has resulted in increased levels of uninsured individuals in this region (demographic and workforce data specific for Ephrata Community Hospital's primary service area is not publicly reported by state or federal agencies).Within Lancaster County's population, the Pennsylvania Department of Health reports that heart disease, cancer, stroke, respiratory disease and diabetes are the five leading disease-related causes of death. Ephrata Community Hospital offers services and programs specifically targeting these diseases. For example, The Ephrata Cancer Center has earned commendations from the American College of Surgeons' Commission on Cancer for the full complement of services available in this community. The Joint Commission has also awarded Ephrata Community Hospital disease-specific certification in Heart Failure and Stroke Care. Through pulmonary rehabilitation, cardiac rehabilitation and diabetes education programs, a multidisciplinary team of professionals helps patients to manage chronic conditions to avoid more costly interventions and to enhance the patients' quality of life.The community served by Ephrata Community Hospital also includes one of the largest settlements of plain Mennonite and Amish families in the United States. The Plain Population does not utilize commercial or governmental payers for healthcare services, and is therefore considered a self-pay population. Ephrata Community Hospital continues to develop services and payment packages to better serve this demographic segment. Part VI, Line 5: What has been reported in Part II is strictly related to exercises that the organization has participated in to better prepare itself to support the communities it serves in the event of a significant emergency or catastrophic event. Part VI, Line 6: All Board members are independent (are not employees nor family members or contractors of the organization), with all but one member residing within the organization's primary service area. Aside from anesthesia and radiology, which have exclusive contracts, the organization extends medical staff privileges to all qualified physicians in the community. Part VI, Line 7: The Hospital provides inpatient, outpatient, durable medical equipment and home care services to the communities we support, while the Northern Lancaster County Medical Group provides outpatient physician services to those same communities. 1 Lancaster County Medical Foundation 480 New Holland Avenue Lancaster PA 17602 260499498 501(c)(3) 25000 N/A N/A Provide assistance to individuals without insurance who do not qualify for medical assistance. Northern Lancaster County Medical Group 169 Martin Avenue PO Box 1002 Ephrata PA 17522 203033058 501(c)(3) 6695993 n/a n/a Charitable Activities 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization only provides grants or assistance to tax-exempt organizations. X X X X 0 0 0 0 0 0 0 1 0 John M Porter Jr 386593 0 107848 0 9335 0 17150 0 25000 0 545926 0 0 0 VINCENT D GLIELMI DO 210670 0 21500 0 1220 0 14951 0 25000 0 273341 0 0 0 Robert F Graupensberger 199648 0 22500 0 1134 0 14253 0 25000 0 262535 0 0 0 John A Holmes 189006 0 22500 0 0 0 10188 0 25000 0 246694 0 0 0 Peter C Cote MD 363302 0 34466 0 67769 0 17150 0 25000 0 507687 0 0 0 Wilfred A Layne MD 411360 0 20000 0 1307 0 12250 0 25000 0 469917 0 0 0 William Loretan DO 332068 0 38839 0 4659 0 12250 0 25000 0 412816 0 0 0 Steven W Zebert DO 314755 0 13500 0 3732 0 17150 0 25000 0 374137 0 0 0 Il Jun Chon MD 280250 0 14387 0 4350 0 12359 0 25000 0 336346 0 0 0 Part I, Line 7 Officers and highest compensated employees have individual goals and objectives as part of their review process as well as team goals and bonuses. The CEO's bonus is determined by the board; all others are determined by the CEO. Lancaster Municipal Authority 237334160 2010-02-01 4570000 Refund 1996 bonds and pay issuance costs 0 0 Lancaster Municipal Authority 237334160 2009-11-09 23930000 Refund 2006 bonds and pay issuance costs 0 0 4570000 4518805 51195 1 0 1 1 23930000 23740000 190000 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 0 0 0 0 0 1 0.00000 0.00000 0.00000 0 0 1 0 0 0 0 0 1 0 0 0 0 Form 990, Part VI, Section B, line 11 The organization's Form 990 is reviewed with the Finance Committee after completion and filing due to the timing of the Committee's meeting and filing deadlines. Form 990, Part VI, Section B, line 12c Board members, officers, and key employees review and sign the conflict of interest policy annually. The organization's legal department reviews the signed statements and addresses any potential or actual conflicts of interest. Form 990, Part VI, Section B, line 15 An outside consultant is used to review comparative compensation for all executive management positions (Assistant Vice President and above). Each position is reviewed to coincide with the anniversary date of the incumbent. This information is used by the Executive Compensation Committee in determining the appropriate level of compensation. Decisions of the Executive Compensation Committee are documented. This process is used each year. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements will be made available to the public upon request. The organization reserves the right to deny requests. FORM 990, PART VI, LINE 16B JOINT VENTURE POLICY THE HOSPITAL DOES NOT CURRENTLY HAVE A FORMAL, WRITTEN POLICY REGARDING JOINT VENTURES. HOWEVER, THE HOSPITAL'S LEGAL DEPARTMENT EVALUATES ALL POTENTIAL JOINT VENTURE ARRANGEMENTS AND TAKES STEPS TO SAFEGUARD THE HOSPITAL'S EXEMPT STATUS WITH RESPECT TO JOINT VENTURES. Northern Lancaster County Medical Group 169 Martin Avenue PO Box 1002 Ephrata PA 17522 203033058 Physician Practices PA 501(c)(3) Line 11b, II N/A THE REHAB CENTER 855 Springdale Drive Suite 200 Exton PA 19341 251687903 PHYSICAL THERAPY REHAB PA N/A RELATED 519105 252079 0 1 1 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 NORTHERN LANCASTER COUNTY MEDICAL GROUP B 6695993 The Rehab Center L 648000 NORTHERN LANCASTER COUNTY MEDICAL GROUP A 804007