| Client Note 1 |
Client Note 1 - Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder |
Northern Lancaster County Medical Group ("NLCMG) is the sole corporate member of Physician Specialists of Northern Lancaster County Medical Group. NLCMG is a related, tax-exempt organization. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body |
Northern Lancaster County Medical Group, as the sole corporate member, has the right to amend the Articles of Incorporation and the Bylaws of Physician Specialists of Northern Lancaster County Medical Group. The board of directors of Physician Specialists of Northern Lancaster County Medical Group may submit proposed amendments to the Northern Lancaster County Medical Group for approval. |
| Form 990, Part VI, Line 11b: Form 990 Review Process |
Management provided an electronic copy of the form 990 to each voting member of the organization's governing body, prior to its filing with the IRS. The organization's finance management team provided a presentation to the Audit Committee on the organization's 990 return. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts |
Officers, directors, and key employees fill out a WellSpan Health Conflict of Interest Disclosure Statement questionnaire annually. The questionnaire is administered by the Internal Audit Department of WellSpan Health, the Parent Company.There shall be full disclosure by any Director having a business or personal interest or relationship which may be in conflict with the interests of the Corporation. After such disclosure the Director shall abide by the determination of the Board of Directors as to whether a conflict exists, the extent to which, if at all, the Director will be permitted to be present during the Board of Directors' discussion of the matter in which the Director may be interested, and whether the Director will be permitted to participate in such discussion and cast a vote in such matter. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management |
See following explanation for 15b. Description for compensation and approval of CEO, executive director or top management is included here. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees |
The Compensation Committee of WellSpan Health is responsible for rewarding and reinforcing key executives for the achievement of annual and long-term performance objectives. The Compensation Committee shall consist of not more than six (6) persons, of whom two (2) shall be the Chairman and Vice Chairman of the Board of the Corporation, and the remaining members shall be such other persons as may be appointed by the Chairman of the Board of the Corporation, with the approval of the Board of Directors; provided, however, that the Compensation Committee shall not include any persons who are employed by the System. The Chairman of the Board of Gettysburg Hospital shall participate. The role of the Compensation Committee is to set the Executive Compensation Philosophy for the system and ensure adherence, evaluate performance and establish compensation for the WellSpan President, evaluate team performance of the executive team and establish awards, review and approve senior executive base salary ranges, and oversee employed physician compensation programs. The Committee will approve salary ranges for each executive position and review incumbent salaries annually. The Committee will be responsible for reviewing the President's salary each year, and if warranted, authorizing an adjustment to maintain competitiveness. The President will have the authority to make salary adjustments for subordinate positions. The Committee is responsible for approving and authorizing payment of the performance awards. The Committee will approve and authorize payment of the President's performance awards. Integrated Healthcare Strategies, Inc., based in Minneapolis Minnesota is the external consultant to the committee. This consultant focuses exclusively on executive and physician compensation in the health care industry. In summary, the executive and physician compensation review process consists of the following: 1) Cash compensation reviewed annually 2) Cash compensation reviewed by external consultant biennially 3) external total compensation (cash, incentives, benefits, perquisites) reviewed by external consultant periodically 4) Process is integrated with compensation analysis for other WellSpan positions 5) Committee decisions are documented in minutes maintained in Human Resources. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available |
Governing documents, policies, and financial statements are available upon request. |
| Form 990, Part V, Line 1, 1099 Filing |
Accounts payable payments of Northern Lancaster County Medical Group ("Medical Group") are consolidated under the common reporting system of Ephrata Community Hospital ("Hospital"), an affiliated, tax-exempt organization. Since totals for each vendor may contain transactions from both the Hospital and the Medical Group, the number of 1099s filed on behalf of the Medical Group by the Hospital and the dollar amounts cannot be separately identified and determined. |
| 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. |
| Signature Block - Paid Preparer Explanation |
Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
| Part II Signature Block |
Paid Preparer ExplanationDue to a software limitation, we wish to clarify that WellSpan Health is the ERO.The paid preparer is:BDO USA, LLP13-53815908401 Greensboro Drive, Suite 800McLean, VA 22102(703) 893-0600The preparers name is Jeffrey Schragg, PTIN P00234543 |
Attach to Form 990 or 990-EZ.