2017-05-08T07:44:37-05:00 2016-06-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2015-07-01 232215800 THE GOOD SHEPHERD HOME LONG-TERM CARE FACILITY INC GOOD 6107763228 GOOD SHEPHERD PLAZA 850 S 5TH ST ALLENTOWN PA 181033295 RONALD J PETULA SVP OF FINANCE & CFO 6107763228 2017-04-28 1 JULIUS C GREEN CPA P00350393 2159720701 2015 2021-01-29 14:40:06Z RONALD J PETULA GOOD SHEPHERD PLAZA 850 S 5TH ST ALLENTOWN PA 181033295 22789310 0 X WWW.GOODSHEPHERDREHAB.ORG X 1982 PA TO ENHANCE LIVES,MAXIMIZE FUNCTION,INSPIRE HOPE AND PROMOTE WELL-BEING WITH COMPASSION 20 19 269 121 0 0 534801 519563 22066581 22269747 0 0 0 0 22601382 22789310 0 0 0 0 12608818 13315023 0 0 0 9988544 10000544 22597362 23315567 4020 -526257 42928895 42462487 749351 809200 42179544 41653287 X GOOD SHEPHERD'S MISSION IS: "MOTIVATED BY THE DIVINE GOOD SHEPHERD AND THE PHYSICAL AND COGNITIVE REHABILITATION NEEDS OF OUR COMMUNITIES, OUR MISSION IS TO ENHANCE LIVES, MAXIMIZE FUNCTION, INSPIRE HOPE, AND PROMOTE DIGNITY AND WELL-BEING WITH EXPERTISE AND COMPASSION." 0 0 20785583 0 22269747 THE GOOD SHEPHERD HOME AT THE CONRAD W. RAKER CENTER AND THE GOOD SHEPHERD HOME-BETHLEHEM ARE RESIDENCES WHERE PERSONS WITH PHYSICAL DISABILITIES REQUIRING NURSING FACILITY CARE CAN COME TO LIVE AND REALIZE THEIR FULLEST POTENTIAL. SERVICES PROVIDED INCLUDE NURSING AND MEDICAL SERVICES, OCCUPATIONAL THERAPY, COMMUNICATION SERVICES, PASTORAL CARE, SOCIAL WORK SERVICES, THERAPEUTIC RECREATION, PHYSICAL THERAPY, ADAPTIVE WHEELCHAIR, MOBILITY AND SEATING PROGRAMS. MANY OF THE RESIDENTS UTILIZE GOOD SHEPHERD'S ASSISTIVE TECHNOLOGY PROGRAM TO HELP WITH THEIR MOBILITY, COMMUNICATION AND EVERYDAY LIVING NEEDS. IN FISCAL YEAR 2016, THE RAKER CENTER OPERATED AT 99.6% OCCUPANCY, WITH 36,077 PATIENT DAYS, WHILE THE BETHLEHEM HOME OPERATED AT 99.9% OCCUPANCY, WITH 21,946 PATIENT DAYS. THERE IS A WAITING LIST FOR BOTH HOMES. 20785583 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 269 1 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 PA X RONALD J PETULA SVP OF FINANCE & CFO 6107763228 GOOD SHEPHERD PLAZA 850 SOUTH 5TH ALLENTOWN PA 18103 SCOTT A BAKER SECRETARY 0.30 0.80 X X 0 0 0 PATRICK J BRENNAN MD TRUSTEE 0.30 0.80 X 0 0 0 DAVID G DECAMPLI CHAIR 0.70 2.00 X X 0 0 0 ALVARO DIAZ TRUSTEE 0.30 0.80 X 0 0 0 SANDRA BODNYK TRUSTEE 0.30 0.80 X 0 0 0 PAUL EMRICK TRUSTEE 0.30 0.80 X 0 0 0 F MARK GUMZ VICE CHAIR 0.30 0.80 X X 0 0 0 ELSBETH G HAYMON TRUSTEE 0.30 0.80 X 0 0 0 SANDRA JARVA WEISS ESQ TRUSTEE 0.30 0.80 X 0 0 0 JOHN KRISTEL PRESIDENT/CEO 6.50 53.50 X X 0 677444 28919 JAAN PETER NAKTIN MD TRUSTEE 0.30 0.80 X 0 0 0 ROSALIN PETRUCCI TRUSTEE 0.30 0.80 X 0 0 0 GARY SCHMIDT TRUSTEE 0.30 0.80 X 0 0 0 DONALD SNYDER TRUSTEE 0.30 0.80 X 0 0 0 LAURIE STEWART TREASURER 0.30 0.80 X X 0 0 0 DANIEL J WILSON PHD TRUSTEE 0.30 0.80 X 0 0 0 JAN S HELLER TRUSTEE 0.30 0.80 X 0 0 0 JOHN C RICHTER TRUSTEE 0.30 0.80 X 0 0 0 ERIC T YOUNG MD TRUSTEE 0.30 0.80 X 0 0 0 JONATHAN WARNER TRUSTEE 0.30 0.80 X 0 0 0 SAMUEL A MIRANDA JR SVP & CNO 5.00 55.00 X 0 286884 25802 RONALD PETULA SVP & CFO 6.50 53.50 X 0 288794 17625 FRANCES R IANNACCONE ADMINISTRATOR LTC 60.00 X 107428 0 8750 JOSEPH A SHADID ADMINISTRATOR LTC 60.00 X 115552 0 21101 222980 1253122 102197 2 0 1 0 SODEXO OPERATIONS LLC 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 DIETARY/FOOD SERVICE 454568 1 519563 519563 NET PATIENT SVC REV 623000 22269747 22269747 22269747 22789310 22269747 0 0 9787833 9407604 380229 952678 915669 37009 1870908 1798229 72679 703604 676787 26817 607853 535367 72486 391946 382828 9118 5628 4900 728 15602 13932 1670 125 125 1276941 1276941 CORPORATE ALLOCATION 6821747 4911658 1910089 MEDICAL SUPPLIES 806782 806311 471 BAD DEBT EXPENSE 21211 21211 DUES & SUBSCRIPTIONS 12936 951 11985 39773 33195 6578 23315567 20785583 2529984 0 1400 1400 3272733 2898517 4670 8010 26296083 19481157 7426009 6814926 32224083 32739634 42928895 42462487 595811 656584 153540 152616 749351 809200 X 42179544 41653287 42179544 41653287 42928895 42462487 -526257 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 56370 56370 10120720 7596372 2524348 15459538 11510644 3948894 659455 374141 285314 6814926 RESIDENT FUNDS 152616 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 246412 AMOUNTS DUE FROM AFFILIATES 32340606 32739634 X 22768099 -21211 -21211 22789310 0 22789310 23294356 0 23294356 21211 21211 23315567 PART IV, LINE 2B: GOOD SHEPHERD ACTS AS CUSTODIAN OF FUNDS HELD FOR THE RESIDENTS LIVING IN THE FACILITIES. THE FUNDS ARE SET ASIDE IN A SEPARATE BANK ACCOUNT FROM THE GENERAL OPERATING FUNDS. RESIDENTS HAVE ACCESS TO THEIR FUNDS ON A DAILY BASIS AND RECEIVE MONTHLY STATEMENTS OF ACTIVITY. PART X, LINE 2: GOOD SHEPHERD PRESCRIBES A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY IN RECORDING TAX LIABILITIES IN THE FINANCIAL STATEMENTS. MEASUREMENT AND RECOGNITION OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. GOOD SHEPHERD'S POLICY IS TO RECOGNIZE INTEREST RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST EXPENSE AND PENALTIES IN OPERATING EXPENSES. GOOD SHEPHERD'S FEDERAL EXEMPT ORGANIZATION RETURNS OF INCOME TAX AND ITS BUSINESS INCOME TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2013 NO LONGER REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -21,211. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 21,211. 0 0 0 0 0 0 0 1 0 JOHN KRISTEL PRESIDENT/CEO 0 489408 0 188036 0 0 0 12309 0 16610 0 706363 0 0 SAMUEL A MIRANDA JR SVP & CNO 0 231142 0 55742 0 0 0 12645 0 13157 0 312686 0 0 RONALD PETULA SVP & CFO 0 228231 0 60563 0 0 0 6584 0 11041 0 306419 0 0 PART I, LINE 3 THE CEO IS COMPENSATED BY GOOD SHEPHERD REHABILITATION NETWORK ("GSRN"), AN AFFILIATED TAX-EXEMPT ORGANIZATION. THE GOOD SHEPHERD HOME LONG-TERM CARE FACILITY, INC. RELIED ON GSRN'S USE OF COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION EXCEPT FOR REVIEW OF WRITTEN EMPLOYMENT CONTRACTS. PART I, LINE 7 GSRN HAS A PERFORMANCE COMPENSATION PROGRAM IN PLACE WHICH IS APPROVED BY THE BOARD. CERTAIN MEMBERS OF MANAGEMENT CAN RECEIVE AN ANNUAL PERFORMANCE PAYMENT ONLY WHEN PRE-DEFINED AND PRE-APPROVED FINANCIAL AND NON-FINANCIAL GOALS ARE ACHIEVED. FOR FISCAL YEAR 2016, A PERFORMANCE PAYMENT WAS ACHIEVED. THE ACTUAL PAYMENT OCCURS IN SEPTEMBER OF THE FOLLOWING FISCAL YEAR. THIS IS NOT GUARANTEED EACH YEAR. FORM 990, PART V, LINE 1: ACCOUNTS PAYABLE PAYMENTS ARE CONSOLIDATED UNDER A COMMON REPORTING SYSTEM. SINCE TOTALS FOR EACH VENDOR MAY CONTAIN TRANSACTIONS FROM MULTIPLE CORPORATIONS, THE NUMBER OF 1099'S FILED ON BEHALF OF THE GOOD SHEPHERD HOME LONG-TERM CARE FACILITY, INC. ("LTC") BY THE COMMON REPORTING AGENT CANNOT BE SEPARATELY IDENTIFIED AND DETERMINED. FORM 990, PART V, LINE 2: THE SALARY AND BENEFIT EXPENSES REPORTED ON FORM 990, PART IX, AND THE EMPLOYEE INFORMATION REPORTED ON FORM 990, PART VII, ARE THE GOOD SHEPHERD HOME LONG-TERM CARE FACILITY, INC.'S ("LTC") ALLOCATED PAYROLL COSTS BASED ON TIME SPENT. ALL INDIVIDUALS WORKING AT LTC ARE EMPLOYEES OF THE GOOD SHEPHERD REHABILITATION HOSPITAL ("GSRH") AND ARE REPORTED ON ITS FORM W-3 UNDER EIN: 23-1371947. GSRH IS AN AFFILIATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS THE GOOD SHEPHERD REHABILITATION NETWORK ("GSRN"), A RELATED TAX-EXEMPT ENTITY. GSRN HAS THE ULTIMATE AUTHORITY AND RESPONSIBILITY FOR THE FOLLOWING ACTIVITIES WITH RESPECT TO THE GOOD SHEPHERD HOME LONG-TERM CARE FACILITY, INC.: AMENDMENT, APPROVAL OR REVOCATION OF BYLAWS; INSTITUTIONAL DEVELOPMENT; CORPORATE AND STRATEGIC PLANNING; FINANCIAL PLANNING AND BUDGETING; AUDIT AND FISCAL MATTERS; RESOURCE ALLOCATION; PUBLIC RELATIONS; APPOINTMENT OF TRUSTEES AND OFFICERS; COMPENSATION AND HUMAN RESOURCE POLICIES; MEDICAL STAFF AND GENERAL POLICY MATTERS. FORM 990, PART VI, SECTION A, LINE 7B SEE EXPLANATION FOR FORM 990, PART VI, SECTION A, LINE 7A. FORM 990, PART VI, SECTION B, LINE 11 THE IRS FORM 990 IS PREPARED USING INFORMATION SOLICITED FROM OFFICERS, DIRECTORS, TRUSTEES, BOARD COMMITTEE MEMBERS, AND MANAGEMENT. THIS GROUP OF INDIVIDUALS ARE PROVIDED A DRAFT RETURN BEFORE THE FINAL RETURN IS FILED. QUESTIONS, COMMENTS, AND ADDITIONAL INFORMATION PROVIDED BY THIS GROUP ARE INCORPORATED INTO THE FINAL RETURN. THE FINAL RETURN IS REVIEWED AT A COMMITTEE LEVEL OF THE BOARD PRIOR TO IT BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THERE IS A SYSTEMATIC PROCESS COORDINATED THROUGH THE GOVERNANCE COMMITTEE WHERE THE CONFLICT OF INTEREST STATEMENTS COMPLETED ANNUALLY BY BOARD MEMBERS AND SENIOR LEADERSHIP TEAM MEMBERS ARE REVIEWED BY THE GOVERNANCE COMMITTEE. WHENEVER THE COMMITTEE FEELS THE CONFLICT STATEMENT IS EITHER INCOMPLETE OR FEELS SOMETHING MAY BE MISSING, THE COMMITTEE WILL ASK MANAGEMENT TO PURSUE FURTHER DUE DILIGENCE. WHEN A BOARD MEMBER DOES HAVE AN INHERENT CONFLICT, THE TRUSTEE IS ASKED TO EITHER ABSTAIN FROM VOTING OR EXCUSE HIMSELF FROM THE ROOM DURING THE DISCUSSION AND VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES OF GOOD SHEPHERD REHABILITATION NETWORK (GSRN) DELEGATES RESPONSIBILITY FOR ADHERENCE TO ALL LEGAL AND REGULATORY REQUIREMENTS AFFECTING EXECUTIVE COMPENSATION TO THE HUMAN RESOURCES/COMPENSATION COMMITTEE OF THE BOARD (THE COMMITTEE). THE COMMITTEE IS PERMITTED TO ENGAGE EXTERNAL RESOURCES AS NECESSARY TO EDUCATE THE COMMITTEE REGARDING NEW LEGAL OR REGULATORY GUIDELINES, MARKET TRENDS AND TO SUPPORT DELIBERATIONS AND DECISION MAKING RELATED TO EXECUTIVE COMPENSATION. THE COMMITTEE SELECTED AND UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT, MERCER - A MARSH & MCCLENNAN COMPANY, (THE CONSULTANT) AS A RESOURCE TO ASSIST WITH DECISIONS RELATED TO EXECUTIVE COMPENSATION. IN ACCORDANCE WITH THE COMMITTEE'S ANNUAL WORK PLAN, THE COMMITTEE REVIEWED AT THE JUNE 2016 MEETING THE FOLLOWING: MERCER (US), INC. CERTIFIES THAT IT (1) IS A COMPENSATION CONSULTING FIRM, (2) PERFORMS COMPENSATION VALUATION STUDIES OF THIS TYPE ON A REGULAR BASIS, AND (3) IS QUALIFIED TO PERFORM THE VALUATIONS OF THE TYPE OF PROPERTY OR SERVICES INVOLVED. DURING MERCER'S REVIEW OF EXECUTIVE COMPENSATION, IT WAS FOUND IN THEIR OPINION TO BE FAIR, REASONABLE AND MARKET APPROPRIATE BASED ON THEIR ANALYSIS OF COMPETITIVE COMPENSATION AND BENEFIT PRACTICES FOR FUNCTIONALLY COMPARABLE POSITIONS IN SIMILARLY SITUATED ORGANIZATIONS. ALL OF THE COMPENSATION MEETINGS ARE FORMALLY DOCUMENTED CONSISTENT WITH BEST GOVERNANCE PRACTICES. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C: THE PROCESSES USED BY THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 1: THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHAIRS OF ALL THE BOARD COMMITTEES AS WELL AS THE CHAIR AND VICE CHAIR OF THE BOARD. ALL EXECUTIVE COMMITTEE MEMBERS ARE MEMBERS OF THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE CAN ACT ON BEHALF OF THE BOARD OF TRUSTEES IN MOST CASES. ANY FUNDAMENTAL CHANGES WILL GO TO THE FULL BOARD. GOOD SHEPHERD HOUSING DEVELOPMENT CORPORATION GOOD SHEPHERD PLAZA 850 SOUTH 5TH S ALLENTOWN PA 18103 233073390 PROVIDES INDEPENDENT LIVING APTS FOR DISABLED, LOW-INCOME ADULTS PA 501(C)(3) LINE 9 GOOD SHEPHERD REHABILITATION NETWORK 0 GOOD SHEPHERD REHABILITATION HOSPITAL GOOD SHEPHERD PLAZA 850 SOUTH 5TH S ALLENTOWN PA 18103 231371947 PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT REHABILITATION SERVICES PA 501(C)(3) LINE 3 GOOD SHEPHERD REHABILITATION NETWORK 0 GOOD SHEPHERD REHABILITATION NETWORK GOOD SHEPHERD PLAZA 850 SOUTH 5TH S ALLENTOWN PA 18103 232216041 PROVIDES MANAGEMENT SERVICES IN SUPPORT OF ITS TAX-EXEMPT AFFILIATES PA 501(C)(3) LINE 7 N/A 0 PHILADELPHIA POST-ACUTE PARTNERS LLC 1800 LOMBARD STREET PHILADELPHIA PA 19146 208283421 OPERATES INPATIENT REHAB HOSP, ACUTE CARE HOSP & 8 OUTPATIENT FACILITIES PA 501(C)(3) LINE 3 GOOD SHEPHERD REHABILITATION NETWORK 0 THE ALLENTOWN SPECIALTY HOSPITAL INC GOOD SHEPHERD PLAZA 850 SOUTH 5TH S ALLENTOWN PA 18103 233009874 PROVIDES INPATIENT SVCS THROUGH OPERATION OF LONG-TERM ACUTE CARE HOSP PA 501(C)(3) LINE 3 GOOD SHEPHERD REHABILITATION NETWORK 0 GOOD SHEPHERD RECIPROCAL RISK RENTENTION GROUP 7301 RIVERS AVENUE SUITE 230 NORTH CHARLESTON SC 29406 204065112 RISK RETENTION GROUP SC N/A C 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 1 0 1