2011-05-03T15:28:44-07:00 2010-06-30 990 2009-07-01 232907754 Central Pennsylvania Nursing Alliance Inc CENT 7175444926 555 North Duke Street Lancaster PA 17604 F Joseph Byorick 7175444926 2011-05-03 2009 2016-02-24 21:20:13Z Maple Farm Nursing Center F Joseph Byorick 555 North Duke Street Lancaster PA 176043555 1346104 0 X www.lancastergeneralhealth.org X 1997 PA Skilled Nursing Care X 0 0 130 0 0 0 1115 0 9882859 1340540 3866 123 26480 5441 9914320 1346104 0 0 0 0 4898665 1227495 0 0 0 6565534 976045 11464199 2203540 -1549879 -857436 3728074 51109 1014003 0 2714071 51109 To provide long term nursing care and rehabilitate residents requiring skilled care. 0 0 1933039 0 1340540 Nursing Home Care: Central Pennsylvania Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) is a skilled nursing facility licensed for 119 beds and located in Lancaster County, Pennsylvania. The facility purpose is the provide residents with necessary long term nursing care and to rehabilitate residents requiring skilled care. The nursing facility provides access for necessary long-term care for Lancaster County and surrounding areas by collaborating with local hospitals and long-term care agencies. As necessary, assistance is provided with insurance and Medicaid applications and coverage. All residents are provided care without regard to payer type or payment status. (6001 Resident Census Days). The Central Pennsylvania Nursing Alliance's (d.b.a. Maple Farm Nursing Center) assets were sold on 8/31/2009 as reported on Schedule N. 0 0 0 1933039 1 0 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 0 0 1 0 1 0 0 0 1 0 1 0 0 0 1 18 0 1 130 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 1 1 1 1 1 1 0 X F Joseph Byorick CFO 7175444926 555 N Duke Street Lancaster PA 17604 Geoffrey W Eddowes 55 X X 0 318442 84731 Kathleen Bailey 2 X X 0 0 0 Andre W Renna 55 X 0 389599 20534 Jay R Bucher 55 X 0 277056 51072 Jan L Bergen 55 X 0 573732 159413 Marion A McGowan 55 X 0 657656 90232 J Kenneth Brubaker MD 55 X 0 248742 49286 Linda A Welker 55 X 0 108299 30560 Robert P Macina Esq 55 X 0 1000713 139972 Margaret F Costella Esq 55 X 0 237711 36036 Matthew A Hazen 55 X 103419 0 18726 103419 3811950 680562 1 0 1 0 RehabCare Group Inc PO Box 503534 St Louis MO 631503534 Therapy Services 120611 1 0 Medicare/Medicaid Net Patient Revenue 623000 904096 904096 0 0 Other Net Patient Revenue 623000 20421 20421 0 0 Nursing Assessment 623000 416023 416023 0 0 0 0 0 0 1340540 123 0 0 123 0 0 0 0 0 0 0 0 0 0 0 0 Miscellaneous Income 900099 3600 0 0 3600 Rental Revenue 531110 1650 0 0 1650 Cafeteria/Vending Sales 900099 191 0 0 191 0 0 0 0 5441 1346104 1340540 0 5564 0 0 0 0 0 0 0 0 74642 0 74642 0 0 0 0 0 775174 766858 8316 0 78355 70519 7836 0 229486 197663 31823 0 69838 59716 10122 0 0 0 0 0 0 0 0 0 270 0 270 0 0 0 0 0 0 0 0 0 0 0 1278 1278 0 0 3044 3044 0 0 89621 76312 13309 0 0 0 0 0 0 0 0 0 45678 41787 3891 0 787 689 98 0 0 0 0 0 1831 200 1631 0 0 0 0 0 0 0 0 0 0 0 0 0 20104 0 20104 0 Purchased Services 531140 450306 80834 0 Nursing Assessment 350075 350075 0 0 Medical Supplies 73592 73592 0 0 Loss on Disposal of Assets 17625 0 17625 0 Bad Debt Expense -159000 -159000 0 0 2203540 1933039 270501 0 600 0 640016 40460 0 0 1274321 10646 0 0 0 0 0 0 0 0 53804 0 0 0 1750000 0 0 0 0 0 0 0 9333 3 3728074 51109 571092 0 0 0 0 0 0 0 0 0 0 0 35193 0 0 0 407718 1014003 0 X 2714071 51109 0 0 0 0 2714071 51109 3728074 51109 X 0 1 1 X 0 X 1206 520 1054 1115 0 3895 8306264 8221113 8928242 10488981 2821243 38765843 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8307470 8221633 8929296 10490096 2821243 38769738 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 38769738 16010 38359 27996 16980 1752 101097 0 0 0 0 0 0 16010 38359 27996 16980 1752 101097 0 0 0 0 0 0 5837 4289 27914 24287 5397 67724 8329317 8264281 8985206 10531363 2828392 38938559 0.99566 0.99584 0.00260 0.00271 X Other Income Line 12 relates to cafeteria/vending sales as well as other miscellaneous income. 0 0 0 0 0 0 Interest Receivable 3 3 1346104 2203540 -857436 0 0 0 0 -1805526 -1805526 -2662962 1346104 0 0 0 0 0 1346104 0 0 0 1346104 2203540 0 0 0 0 0 2203540 0 0 0 2203540 SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Related Party Contribution to Lancaster General Health (EIN 23-2250941). X X 0 1 X X X X 1 1 0 0 0 0 0 1 0 Matthew A Hazen 53874 0 24995 0 24551 0 3156 0 15571 0 122147 0 0 Kathleen Bailey 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Jan L Bergen 0 396919 0 156807 0 20006 0 100362 0 59051 0 733145 0 0 Jay R Bucher 0 213538 0 42865 0 20654 0 9800 0 41272 0 328129 0 0 Geoffrey W Eddowes 0 248767 0 67521 0 2154 0 38918 0 45813 0 403173 0 0 Marion A McGowan 0 456926 0 184417 0 16313 0 9800 0 80432 0 747888 0 0 Andre W Renna 0 65308 0 0 0 324291 0 1633 0 18901 0 410133 0 0 Linda A Welker 0 98712 0 9143 0 444 0 4332 0 26228 0 138859 0 0 Margaret F Costella Esq 0 199735 0 35413 0 2563 0 9508 0 26528 0 273747 0 0 Robert P Macina Esq 0 311537 0 108916 0 580260 0 80541 0 59431 0 1140685 0 0 J Kenneth Brubaker MD 0 226581 0 0 0 22161 0 9800 0 39486 0 298028 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) provided gross-up payments to employees when they received gifts so as to provide tax assistance in that no tax burdens are created with the intended gift. Officers and Directors are compensated by Lancaster General Hospital, EIN 23-1365353, a related organization. Lancaster General Hospital provided gross-up payments to employees and social club dues to certain individuals listed on Schedule J. Lancaster General Hospital provides gross-up payments to employees when they receive gifts so as to provide tax assistance in that no tax burdens are created with the intended gift. The social club memberships are intended for business use with any personal use being taxed to respective individual. Amount included in income for social club dues is reflective of personal use and amounted to $900 in CY 2009. SchJ_P01_S00_L01b Schedule J, Part I, Line 1b There is no written policy currently in place. SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Officers and Directors are compensated by Lancaster General Hospital, EIN 23-1365353, a related organization. The compensation process described below pertains to the CEO, EVPs, SVPs, VPs, and AVPs of Lancaster General Hospital. Lancaster General Hospital utilizes an independent third party to provide base salary and total compensation market data for comparable positions at similarly sized organizations. Lancaster General Hospital presents the performance of the above mentioned positions against established goals and evaluates and presents them to the Management and Development Compensation committee (MDCC). The MDCC is a Committee comprised of independent Board of Trustee members. The market data and performances against goals are reviewed by the MDCC members at their meeting. This documentation is kept for future reference. This process is undertaken each August after the close of the previous fiscal year in June. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Total severance of $23,744 was distributed. Total distributions and/or contributions to a non-qualified Supplemental Retirement Plan amounted to $190,421. Those receiving distributions and/or contributions to this non-qualified plan are as follows: Jan L. Bergen, Geoffrey W. Eddowes, Robert P. Macina, Esq.. SchJ_P01_S00_L07 Schedule J, Part I, Line 7 The purpose of the Lancaster General Health (LG) Annual Incentive Plan (The Plan) is to reinforce strategic performance priorities for senior management and management employees and to encourage the highest level of performance in the delivery of health care services. As a reward for employees' contributions to Lancaster General Health's success, the Plan provides the opportunity to earn meaningful incentive compensation based on the performance of Lancaster General Health and the individual Participants. Specifically, the Plan is designed to: *Focus Participants on the achievement of organization goals related to people, service, quality/safety, financial and growth; *Promote and foster a team oriented culture; *Strengthen Lancaster General Health's ability to attract and retain superior talent, recognize and reward accomplishments that clearly advance the organization's mission, and drive strategies; *Provide incentive awards that can be adjusted annually for different business conditions and business plan priorities without changing basic design features of the Plan; and *Provide annual incentive opportunities with due consideration to the requirements of the Intermediate Sanctions law and the regulations there under. MediQuest Staffing Inc Ms. Bailey is the President and sole owner of MediQuest Staffing, Inc. 82924 Supplemental staffing was provided to the filing organization 0 Asset distributed-Land 2009-09-01 1342500 Cost 232640814 Garden Spot Village 433 South Kinzer Avenue New Holland PA 17557 501(c)(3) Asset distributed-Equipment 2009-09-01 405186 Book value 232640814 Garden Spot Village 433 South Kinzer Avenue New Holland PA 17557 501(c)(3) Asset distributed-Software 2009-09-01 2314 Book value 232640814 Garden Spot Village 433 South Kinzer Avenue New Holland PA 17557 501(c)(3) Transaction expense-Legal fees 2008-06-30 2930 Cost 231886296 Stevens & Lee PO Box 679 Reading PA 196030679 Law firm Transaction expense-Legal fees 2009-06-30 35481 Cost 231886296 Stevens & Lee OP Box 679 Reading PA 196030679 Law firm 0 0 0 1 SchN_P02_S00_L01 Schedule N, Part II, Line 1 The transaction expenses of $2,930 were paid to Stevens & Lee during the period of 7/1/2008 through 6/30/2009 and transaction expenses of $35,481 were paid during the period of 7/1/2009 through 6/30/2010. SchN_P02_S00_L02 Schedule N, Part II, Line 2 Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) provided severance and retention payments to Matthew Hazen. No payments were made nor does a relationship exist between Matthew Hazen and the successor, Garden Spot Village, EIN 23-2640814. F990_P06_S0A_L01a Form 990, Part VI, Section A, Line 1a The Board of Trustees of the Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) was dissolved on 6/24/2009. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The Sole Member of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) is Lancaster General Health (EIN 23-2250941). The Sole member may initiate or implement any proposal with respect to any of the following: amendment of charter, certificate or articles of incorporation or bylaws; sale, purchase, lease, or encumbrance with debt; the transfer of any assets of the Corporation, excluding equipment; election or removal of the Board of Trustees of the Corporation; the approval of the annual operating and capital budgets of the Corporation; the approval of investment advisors, outside legal counsel, and auditors for the Corporation; and the approval of non-budgeted expenditures. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Lancaster General Health (EIN 23-2250941) elects the Board of Trustees of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center). The final meeting of the Board of Trustees of Central Penn Nursing Alliance was held 6/24/2009. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b The Sole Member of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) is Lancaster General Health (EIN 23-2250941). The Sole Member may initiate or implement any propsal with respect to any of the following: amendment of charter, certificate or articles of incorporation or bylaws; sale, purchase, lease, or encumbrance with debt; the transfer of any assets of the Corporation, excluding equipment; election or removal of the Board of Trustees of the Corporation; the approval of the annual operating and capital budgets of the Corporation: the approval of investment advisors, outside legal counsel, and auditors for the Corporation; and the approval of non-budgeted expenditures. F990_P06_S0A_L08a Form 990, Part VI, Section A, Line 8a The Board of Trustees of Central Penn Nursing Alliance, Inc. (d.b.a. Maple Farm Nursing Center) did not meet during the time period of this filing, 7/1/2009 through 6/30/2010. The Board of Trustees was dissolved on 6/24/2009. F990_P06_S0A_L08b Form 990, Part VI, Section A, Line 8b The Board of Trustees of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) did not meet during the time period of this filing 7/1/2009 through 6/30/2010. The Board of Trustees was dissolved on 6/24/2009. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The Board of Trustees of Central Penn Nursing Alliance, Inc. (d.b.a. Maple Farm Nursing Center) did not meet during the time period of this filing, 7/1/2009 through 6/30/2010. The Board of Trustees was dissolved on 6/24/2009. The Form 990 was reviewed by the Chief Financial Officer of Lancaster General Hospital (EIN# 23-1365353). F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c In order to ascertain and evaluate actual or potential conflicts, certain interested persons are required to fill out a Conflict of Interest Disclusure Statement upon entering employment or becoming a trustee of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) or an affiliate, and other are also required to fill out such a statement on an annual basis. In addition to this requirement, all officers and trustees, regardless of whether or not they have been asked to fill out a Conflict of Interest Disclosure Statement, have an ongoing affirmative duty to bring to the attention of Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center), situations which may give rise to an actual or potential conflict of interest as described in the policy. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Officers and Directors are compensated by Lancaster General Hospital, EIN 23-1365353, a related organization. The compensation process described below pertains to the CEO, EVPs, SVPs, VPs, and AVPs of Lancaster General Hospital. Lancaster General Hospital utilizes an independent third party to provide base salary and total compensation market data for comparable positions at similarly sized organizations. Lancaster General Hospital presents the performance of the above mentioned positions against established goals and evaluates and presents them to the Management and Development Compensation committee (MDCC). The MDCC is a Committee comprised of independent Board of Trustee members. The market data and performances against goals are reviewed by the MDCC members at their meeting. This documentation is kept for future reference. This process is undertaken each August after the close of the previous fiscal year in June. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) does not make the governing documents, conflict of interest policy, or financial statements available to the public. F990_P07_S0A_L01a Form 990, Part VII, Section A, Line 1a The average hours per week reported in Column B pertains to the reportable compensation reported in Columns D, E, and/or F. The Board of Trustees of the Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) was dissolved on 6/24/2009. Members of the Board are not compensated for their position on the Board. Compensation disclosed relates to other services performed. F990_P11_S00_L02b Form 990, Part XI, Line 2b The consolidated balance sheet of Lancaster General Health (EIN 23-2250941) and the related consolidated statements of operations and changes in net assets and cash flows are audited by an independent accountant. Central Penn Nursing Alliance Inc. (d.b.a. Maple Farm Nursing Center) is included in the consolidated statements. SchR_P05_S00_L02 Schedule R, Part V, Line 2 All arrangements are negotiated at arm's length and for fair value in compliance with the organization's conflict of interest policy. Affiliates perform inter-company transactions as part of the normal course of business. Lancaster General Health 555 North Duke Street Lancaster PA 17604 232250941 Mgmt & fin. support to controlled org. & undertaking activities to improve the health of community PA 501(c)(3) 509(a)(3)-Type II N/A Lancaster General Health Foundation 555 North Duke Street Lancaster PA 17604 205767147 Organized & operated to support the exempt purposes of member of LG Health PA 501(c)(3) 509(a)(3)-Type III Lancaster General Health Lancaster General Hospital 555 North Duke Street Lancaster PA 17604 231365353 Acute primary and secondary care PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Health Lancaster General Medical Group 1030 New Holland Avenue Lancaster PA 17601 232777286 Provide charitable primary and specialty healthcare PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Health Lancaster Cleft Palate Clinic 223 North Lime Street Lancaster PA 17602 231306888 Provide treatment for oral-facial deformities PA 501(c)(3) 170(b)(1)(A)(vi) Lancaster General Health Lancaster General Health-Columbia Center 306 North 7th Street Columbia PA 17512 230485650 Acute Primary Care/Facility Mgmt Op Svcs PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Hospital Lancaster General College of Nursing & Health Sciences 410 North Lime Street Lancaster PA 17602 061645496 Provide support and promote healthcare education PA 501(c)(3) 170(b)(1)(A)(ii) Lancaster General Hospital VNA Community Care Services Inc PO Box 10788 Lancaster PA 17605 231352572 Provides home health care services PA 501(c)(3) 170(b)(1)(A)(vi) Lancaster General Health Lancaster General Rehabilitation Services Inc 555 North Duke Street Lancaster PA 17604 204943109 Investment in Rehabilitation Hospital PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Health Lancaster General Ambulatory Surgical Services Inc 555 North Duke Street Lancaster PA 17604 204943239 Investment in Ambulatory Surgery Center PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Hospital Lancaster General Imaging Corporation 609 North Cherry Street Lancaster PA 17604 233102789 Investment in imaging services PA 501(c)(3) 170(b)(1)(A)(iii) Lancaster General Hospital Lancaster Emergency Medical Services Assocation 1829 Lincoln Highway Lancaster PA 17602 232840702 Emergency medical transportation PA 501(c)(3) 509(a)(2) Lancaster General Hospital United Auxiliaries to Lancaster General Hospital 555 North Duke Street Lancaster PA 17604 231976868 To promote and advance Lancaster General Hospital's plans & programs PA 501(c)(3) 509(a)(2) N/A Lancaster Rehabilitation Hospital LLP 675 Good Drive Lancaster PA 17601 208092253 Rehab Hospital PA Related 0 0 0 0 1 Physician's Surgery Center Lancaster General LLC 2150 Harrisburg Pike Lancaster PA 17601 204463521 Surgery Center PA Related 0 0 0 0 1 Lancaster PET Partnership LLP PO BOX 4216 Lancaster PA 17604 233102793 Medical Services PA Related 0 0 0 0 1 MRI Group LLP PO BOX 4216 Lancaster PA 17604 331011386 Medical Services PA Related 0 0 0 0 1 Central Pennsylvania Alliance Laboratory PO BOX 2767 York PA 17405 232910950 Medical Testing PA Related 0 0 0 0 1 Horizon Healthcare Services Inc 1070 New Holland Avenue Lancaster PA 17601 232910102 In-home infusion drug therapy PA Related 0 0 0 0 1 PeriOptimum 24 South Eighteenth Street Pittsburgh PA 15203 251815023 Provides information technology tools & decision support services PA Related 0 0 0 0 1 Lancaster General Insurance Company PO BOX 1109 GT Grand Cayman Cayman Islands CJ KYI-1102 980176655 Insurance CJ Lancaster General Health C 0 0 0 Lancaster General Services Business Trust 607 North Duke Street Lancaster PA 17602 232250128 Owns & operates real estate property, pharmacy & home infusion company PA Lancaster General Health C 0 0 0 Barge Ganse Venacare Business Trust 607 North Duke Street Lancaster PA 17602 232113017 Pharmacy & two thirds ownership interest of home infusion therapy services company PA Lancaster General Services Business Trust C 0 0 0 Preferred Health Care 20-D East Roseville Road Lancaster PA 17601 251533898 Provides management & marketing services PA Lancaster General Health C 0 0 0 Quest Behavioral Health PO Box 2767 York PA 17405 232910565 Behavioral health managed care plan for employers & health plans PA Lancaster General Hospital C 0 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 1 1 0 1 1 Lancaster General Hospital c 80200 Lancaster General Hospital g 421 Lancaster General Hospital l 3389 Lancaster General Hospital n 17757 Lancaster General Hospital o 194405 Lancaster General Hospital q 400000 Lancaster General Hospital r 462000 Lancaster General Health b 1667838