Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MUHLENBERG REGIONAL MEDICAL CENTER
Employer identification number
22-1487258
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
336,265
687,691
303,593
271,775
190,393
1,789,717
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
7,213,881
6,725,960
3,308,468
3,649,798
3,614,200
24,512,307
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
7,550,146
7,413,651
3,612,061
3,921,573
3,804,593
26,302,024
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
77,315
249,868
63,792
34,026
425,001
c
Add lines 7a and 7b..
77,315
249,868
63,792
34,026
425,001
8
Public support (Subtract line 7c from line 6.)
25,877,023
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
7,550,146
7,413,651
3,612,061
3,921,573
3,804,593
26,302,024
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
3,326,659
2,520,739
2,562,936
2,178,498
2,050,927
12,639,759
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
3,326,659
2,520,739
2,562,936
2,178,498
2,050,927
12,639,759
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
425,301
105,041
-20,509
38,747
44,658
593,238
13
Total support. (Add lines 9, 10c, 11, and 12.)..
11,302,106
10,039,431
6,154,488
6,138,818
5,900,178
39,535,021
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
65.453 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
69.280 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
31.971 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
29.415 %
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
MUHLENBERG REGIONAL MEDICAL CENTER
Employer identification number
22-1487258
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS JFK HEALTH SYSTEM, INC. AS ITS SOLE MEMBER.
Form 990, Part VI, Section A, Line 7B
Certain decisions of the governing body of the organization are subject to approval by the member.
Form 990, Part VI, Section B, Line 11
An Ad-hoc Committee, which includes the Chairman of the Audit & Compliance Committee and a selected designee of the Audit and Compliance Committee as well as designees from the Finance, Legal and Audit and Compliance departments, review the IRS 990 Tax Returns with EisnerAmper LLP, the tax accountant for JFK Health System, Inc. During this review, all comments and recommendations that are made are addressed by the Finance, Legal, and Audit and Compliance departments along with EisnerAmper. The final revised drafts are reviewed by the Ad-hoc Committee to ensure all comments and recommendations were addressed in the final drafts. The Audit and Compliance committee has given the Ad-hoc Committee the authority to approve the IRS 990 Tax Returns. Once the IRS 990 Tax Returns are approved by the Ad-hoc Committee, all Board members are sent an e-mail with instructions on how to access the respective IRS 990 Tax Returns for their review and comments for 4 days on a secure website provided by EisnerAmper LLP. At the end of the 4 day review period, and after any comments have been addressed, the IRS 990 Tax Returns are finalized and filed. Also, after the IRS 990 Tax Returns are filed, the returns are posted on the JFK Health System Board Portal.
Form 990, Part VI, Section B, Line 12C
ON AN ANNUAL BASIS, CONFLICT OF INTEREST DISCLOSURE STATEMENTS ARE DISTRIBUTED TO ALL BOARD MEMBERS AND EMPLOYEES THAT ARE DEPARTMENT HEAD AND HIGHER LEVELS. ALL DISCLOSURES ARE REVIEWED BY THE COMPLIANCE OFFICER AND THE CHAIR OF THE JFK HEALTH SYSTEM AUDIT AND COMPLIANCE COMMITTEE. ANY POTENTIAL CONFLICT OF INTEREST IS BROUGHT TO SAID COMMITTEE FOR REVIEW AND CONSIDERATION AND ANY APPROPRIATE ACTION DEEMED NECESSARY PURSUANT TO THE CONFLICT OF INTEREST POLICY.
Form 990, Part VI, Section B, Line 15
THE JFK HEALTH SYSTEM BOARD OF DIRECTORS HAS DULY APPOINTED AN EXECUTIVE COMPENSATION COMMITTEE (THE "COMMITTEE") THAT IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF ALL COMPENSATION AND BENEFITS PROVIDED TO EXECUTIVE MANAGEMENT OF THE ORGANIZATION. THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND AN EXECUTIVE COMPENSATION COMMITTEE CHARTER. THE COMMITTEE FOLLOWS THE PROCEDURES DESCRIBED IN THE PHILOSOPHY STATEMENT AND THE CHARTER WHEN IT REVIEWS AND APPROVES THE COMPENSATION AND EMPLOYEE BENEFITS PROVIDED TO THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER. THE COMMITTEE'S REVIEW ANALYZES EVERY ELEMENT OF COMPENSATION, SUCH AS CURRENT AND DEFERRED COMPENSATION AND BENEFITS, INCLUDING QUALIFIED AND NON-QUALIFIED BENEFITS. THE COMMITTEE CONDUCTS ITS REVIEW AND APPROVAL PROCESS AT LEAST ANNUALLY, AND APPROVES COMPENSATION AND BENEFITS ONLY TO THE EXTENT THAT THE COMMITTEE HAS CONCLUDED THAT THE TOTAL COMPENSATION AND BENEFITS CONSTITUTE NO MORE THAN REASONABLE COMPENSATION. THE COMMITTEE CONSISTS ENTIRELY OF INDEPENDENT MEMBERS OF THE JFK HEALTH SYSTEM BOARD. THE COMMITTEE REVIEWS IN ADVANCE INDEPENDENT DATA SHOWING THE COMPENSATION PROVIDED BY NON-PROFIT ORGANIZATIONS FOR FUNCTIONALLY SIMILAR POSITIONS, AND THE COMMITTEE PREPARES A TIMELY AND THOROUGH RECORD OF ITS DELIBERATIONS AND CONCLUSIONS. ASSISTING THE COMMITTEE IS AN OUTSIDE COMPENSATION CONSULTANT ALONG WITH OUTSIDE LEGAL COUNSEL. AS A RESULT, THE COMMITTEE'S REVIEW PROCESS IS DESIGNED TO SATISFY THE PROCEDURAL CRITERIA NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE FEDERAL INCOME TAX LAW INTERMEDIATE SANCTIONS RULES.
Form 990, Part VI, Section C, Line 19
JFK HEALTH SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AND THE ORGANIZATION'S CONSOLIDATING FINANCIAL STATEMENTS ARE POSTED ON THE JFK HEALTH SYSTEM WEBSITE; ANY OTHER PUBLIC INFORMATION IS AVAILABLE UPON REQUEST.
Form 990, Part XI, Line 9
Changes in Net Assets: Change in valuation of beneficial interest in perpetual trusts 251,681 change in beneficial interest in assets of muhlenberg foundation 558,386 loss from discontinued operations (249,665) pension/postretirement liability adjustment 5,068,955 Provision for Doubfful Collections on Related Party Receivables (24,691) Pension Settlement (96,565) TRANSFER FROM THE COMMUNITY HOSPITAL GROUP, INC. 5,313,268 Total to Form 990, Part XI, Line 9 10,821,369
Form 990, Part XII, Question 2C
THE PROCESS HAS NOT CHANGED SINCE LAST YEAR. JFK HEALTH SYSTEM HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
Extension
Description of why the return was not timely filed AWAITING INFORMATION FROM THIRD PARTIES WHICH IS NECESSARY TO FILE A COMPLETE AND ACCURATE RETURN.
Form 990, Part VII
Method employed in determination of estimated hours per week DURING THE ANNUAL BUDGET PROCESS, THE FINANCE DEPARTMENT PERFORMS AN ANALYSIS OF THE EXECUTIVE LEVEL EMPLOYEES' TIME ALLOCATION FROM TIME KEEPING RECORDS. THE APPROPRIATE ADJUSTMENTS ARE MADE TO THE TIME ALLOCATIONS AT THAT TIME. THE HOURS PER WEEK FOR OFFICERS OF JFK HEALTH SYSTEM ARE ALLOCATED AMONGST MANY OF THE RELATED ORGANIZATIONS.
Form 990, Part I, Question 1
Briefly describe the organization's mission MUHLENBERG REGIONAL MEDICAL CENTER IS COMMITTED TO EXCELLENCE IN PROVIDING QUALITY AND COMPASSIONATE HEALTHCARE SERVICES TO DIVERSE COMMUNITIES.
Schedule R, Part V, Line 1O
JFK HEALTH SYSTEM MAINTAINS A MASTER EMPLOYEE LEASING AGREEMENT THAT PROVIDES FOR THE LEASING OF PERSONNEL TO AND FROM VARIOUS JFK ENTITIES.
Form 990, Part VI, Section A, Line 7A
WHILE THE MEMBER CANNOT ELECT OR APPOINT ONE OF MORE MEMBERS OF THE GOVERNING BODY, ALL BOARD APPOINTMENTS ARE SUBJECT TO APPROVAL BY THE MEMBER. THE DIRECTORS, OTHER THAN EX-OFFICIO DIRECTIONS ARE ELECTED BY A VOTE OF THE BOARD AT THE ANNUAL MEETING OF THE CORPORATION. THE DIRECTOR MEMBERSHIP COMMITTEE SHALL NOMINATE A SLATE OF DIRECTORS TO SERVE AS OFFICERS TO REPLACE OR REELECT THOSE OFFICERS WHOSE TERMS ARE ENDING.
Form 990, Part VII
DEFINITION OF EX-OFFICIO A PERSON WHO HOLDS A POSITION BY VIRTUE OF THEIR OFFICE
SCHEDULE K, PART 1
THE REFINANCING OF VARIOUS SERIES OF BONDS ISSUED ON BEHALF OF, AND OTHER INDEBTEDNESS OF, JFK MEDICAL CENTER, HARTWYCK AT OAK TREE AND MUHLENBERG REGIONAL MEDICAL CENTER, AS DESCRIBED BELOW, ALL IN CONNECTION WITH THE TERMINATION OF THE PROVISION OF HOSPITAL ACUTE CARE SERVICES AT MUHLENBERG REGIONAL MEDICAL CENTER AND PURSUANT TO THE STATE'S HOSPITAL ASSET TRANSFORMATION PROGRAM. ADVANCE REFUNDING OF 2000 BONDS $16,649,481 COSTS OF ISSUANCE $270,887
FORM 990, PART III, QUESTION 3
MUHLENBERG REGIONAL MEDICAL CENTER (MRMC) IS A NONPROFIT AFFILIATE OF JFK HEALTH SYSTEM, INC. SINCE CLOSING ITS ACUTE CARE INPATIENT SERVICES IN AUGUST 2008, MRMC HAS CONTINUED TO OPERATE ITS HOME CARE PROGRAM, HOWEVER, EFFECTIVE AS OF JANUARY 1, 2011, THE HOME CARE PROGRAM IS OPERATED THROUGH A JOINT VENTURE MRMC FORMED WITH ANOTHER TAX EXEMPT HEALTHCARE PROVIDER, JFK Meridian Home Care Services, LLC D/B/A JFK AT HOME. AS SUCH, THE OPERATIONS OF THE MUHLENBERG HOME CARE DEPARTMENT CEASED AS OF DECEMBER 31, 2010. IN CONNECTION WITH THE FORMATION OF THE JOINT VENTURE, MRMC TRANSFERRED PROPERTY AND EQUIPMENT TO JFK AT HOME FOR 50% OWNERSHIP IN THE NEW JOINT VENTURE IN 2011. THE INVESTMENT IN JFK AT HOME WILL BE ACCOUNTED FOR ON THE EQUITY METHOD OF ACCOUNTING AND INCLUDED ON THE CONSOLIDATED BALANCE SHEET.
SCHEDULE A, PART III, SECTION A
Amendment to Schedule A, Public Support Test Change to Section A, line 2, columns (c) - (e): The gross receipts were adjusted to reflect Muhlenberg Regional Medical Center's (MRMC's) share of receipts in JFK Meridian Home Care Services, LLC, a joint venture formed with another tax exempt provider. The amounts originally reported on line 2, column (c) - (e) were $97,953, $455,218, and $299,952, respectively and were changed to $3,308,468, $3,649,798, and $3,614,200, respectively. Refer to the Form 990, Part III, Question 3 footnote for more information on the joint venture. Change to Section A, line 7b, columns (a) - (d): There were no amounts originally reported. The adjusted amounts in columns (a) - (d) are $77,315, $249,868, $63,792, and $34,026, respectively.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.