2011-05-12T06:53:04-05:00 2010-06-30 ParenteBeard LLC 1650 Market Street Suite 4500 Philadelphia PA 19103 990 2009-07-01 203033058 Northern Lancaster County Medical Group NORT 7177386660 169 Martin Avenue PO Box 1002 Ephrata PA 17522 John A Holmes 7177386660 2011-05-10 1 Julius Green CPA 2159720701 2009 2016-02-24 21:20:13Z Robert P Graupensperger 169 Martin Avenue PO Box 1002 Ephrata PA 17522 32408910 0 X www.nlcmg.org X 2005 PA NON-PROFIT GROUP OF PHYSICIAN PRACTICES PROVIDING PREVENTIVE, PRIMARY CARE AND SPECIALTY SERVICES. 10 5 391 10 21260 -10601 6989993 25545161 25185549 9 0 22287 233368 25567457 32408910 500 575 0 22875924 23090261 0 0 8316832 8257309 31193256 31348145 -5625799 1060765 4566753 5444881 14169113 13986476 -9602360 -8541595 Our Mission is to provide quality, compassionate, and cost-effective healthcare in Lancaster County. 0 0 29697404 575 25249299 The Northern Lancaster County Medical Group is a non-profit group of physician practices that provide preventive services, primary care as well as specialty services to the residents of northern Lancaster County and surrounding communities. Our staff includes physicians, physician assistants, nurse practitioners, certified nurse midwives, registered nurses as well as other professionals in 25 office locations across the community. In addition to the care provided in the office or hospital setting, Northern Lancaster County Medical Group providers also presented free health education programs, and offered free health screenings to community residents during the fiscal year that ended June 30, 2010. 29697404 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 391 1 1 1 0 0 0 0 0 0 0 0 10 5 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 PA X John A Holmes CFO 7177386753 169 Martin Ave PO Box 1002 Ephrata PA 175221002 Fred Groff 2.00 X X 0 0 0 Dean A Stoesz 1.00 X 0 0 0 Il Jun Chon MD 40.00 X 0 298987 37359 T Scott Jackson MD 20.00 X 94763 0 19681 Stacie Marrie MD 28.00 X 73596 0 18168 Madonna Talbert MD 40.00 X 228805 0 36029 Kent C Trachte PhD 1.00 X 0 0 0 Bruce Waskowicz MD 40.00 X 207136 0 35821 Linda Weaver 1.00 X 0 0 0 Paul M Zimmerman Jr 1.00 X X 0 0 0 Cynthia Malizia 40.00 X X 154822 0 33171 Williams C Piepgrass MD 40.00 X 600080 0 37250 John Joseph MD 40.00 X 387798 0 37250 Joseph J Irwin MD 40.00 X 356222 0 41192 Susan R Hovenden MD 40.00 X 346461 0 36465 John R Frederick MD 40.00 X 342410 0 36639 2792093 298987 369025 43 0 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Temporary Staffing 202132 1 6695993 294000 6989993 Net patient service re 621110 25185549 25185549 25185549 15021 15021 15021 15021 Billing & Collection R 561000 154597 21260 133337 Miscellaneous Rev 900099 63750 63750 218347 32408910 25249299 21260 148358 575 575 901992 713999 187993 18978543 18423612 554931 887335 853311 34024 1202780 1200789 1991 1119611 1080265 39346 21861 21861 143698 143698 1104880 966222 138658 155617 142625 12992 2173637 2109014 64623 2105773 2076993 28780 171024 167091 3933 14551 6989 7562 27771 27771 500377 317753 182624 721458 692413 29045 Bad Debt Expense 581936 581936 Recruitment Expense 174593 11295 163298 Professional Developmen 111851 111321 530 Repairs & Maintenance 100581 98028 2553 Licenses & Dues 85708 82863 2845 61993 60310 1683 31348145 29697404 1650741 0 3687 3687 109028 310445 2053981 2763755 75210 58750 20588 44132 4949602 3243844 1668499 1705758 334735 432417 301025 125937 4566753 5444881 2794502 2627566 313713 254583 11060898 11104327 14169113 13986476 X -9602360 -8835595 294000 -9602360 -8541595 4566753 5444881 X 0 1 1 X 0 X X X X 0 0 0 Ephrata Community Hospital 231470484 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 87842 87842 509608 263548 246060 1103086 612331 490755 3133059 2340996 792063 116007 26969 89038 1705758 PENSION LIABILITY 2353288 Due to affiliate 8276911 Deferred Compensation 429128 Estimated Third Party Payor Settlements 45000 11104327 32408910 31348145 1060765 0 1060765 32408910 0 32408910 0 32408910 31348145 0 31348145 0 31348145 Part X: Description of Uncertain Tax Positions Under FIN 48: The organization 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. 0 0 0 0 0 0 0 1 0 Il Jun Chon MD 0 280250 0 14387 0 4350 0 12359 0 25000 0 336346 0 0 Madonna Talbert MD 200012 0 5000 0 23793 0 11029 0 25000 0 264834 0 0 0 Bruce Waskowicz MD 178073 0 25045 0 4018 0 10821 0 25000 0 242957 0 0 0 Cynthia Malizia 134822 0 20000 0 0 0 8171 0 25000 0 187993 0 0 0 Williams C Piepgrass MD 593006 0 0 0 7074 0 12250 0 25000 0 637330 0 0 0 John Joseph MD 328934 0 48000 0 10864 0 12250 0 25000 0 425048 0 0 0 Joseph J Irwin MD 249956 0 106266 0 0 0 16192 0 25000 0 397414 0 0 0 Susan R Hovenden MD 326502 0 19959 0 0 0 11465 0 25000 0 382926 0 0 0 John R Frederick MD 327410 0 15000 0 0 0 11639 0 25000 0 379049 0 0 0 Part I, Line 7 Non-fixed payments include bonuses which are determined based on individual contracts and may include factors such as productivity, coding accuracy, etc. Madonna L Talbert MD Employment Agreement-Amount will be forgiven after five years of employment X 90000 58750 0 1 1 58750 FORM 990, PART V, LINE 2 NUMBER OF EMPLOYEES REPORTED ON FORM W-3 All individuals working at Northern Lancaster County Medical Group ("Medical Group") are employees of Ephrata Community Hospital ("Hospital") and are reported on its Form W-3 under EIN: 23-1370484. The salary and benefit expenses reported on Form 990, Part IX, are the Medical Group's allocated payroll costs based on time spent. The Hospital is an affiliated tax-exempt organization. Form 990, Part VI, Section A, line 6 Ephrata Community Hospital is the sole corporate member of Northern Lancaster County Medical Group. The Hospital is a related, tax-exempt organization. Form 990, Part VI, Section A, line 7a Ephrata Community Hospital, as the sole corporate member, has the right to elect non-physician directors. One of the non-physician directors shall be the Hospital's Chairman of the Board. Form 990, Part VI, Section A, line 7b Ephrata Community Hospital, as the sole corporate member, has the right to amend the Articles of Incorporation and the Bylaws of Northern Lancaster County Medical Group. The Board of Directors of Northern Lancaster County Medical Group may submit proposed amendments to the Hospital for approval. 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 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. Ephrata Community Hospital 169 Martin Ave PO Box 1002 Ephrata PA 175221002 231470484 Hospital PA 501(c)(3) Line 3 N/A 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 1 1