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.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Upper Chesapeake Health System Inc
Employer identification number
52-1398513
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 the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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 support?
Yes
No
Yes
No
Yes
No
(1)
HARFORD MEMORIAL HOSPITAL INC
520591484
03
Yes
Yes
Yes
3,665,672
(2)
UPPER CHESAPEAKE MEDICAL CENTER INC
521253920
03
Yes
Yes
Yes
6,236,065
(3)
UPPER CHESAPEAKE MEDICAL SERVICES INC
521501734
04
Yes
Yes
Yes
920,297
(4)
UPPER CHESAPEAKEST JOE'S HOME CARE INC
521229742
04
Yes
Yes
Yes
0
Total
10,822,034
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
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 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
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—2009.
If the organization did not check the 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—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
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 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or 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) 2010
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.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Upper Chesapeake Health System Inc
Employer identification number
52-1398513
Identifier
Return Reference
Explanation
PART VI, SECTION A, GOVERNING BODY & MANAGEMENT, QUESTION 2
FAMILY OR BUSINESS RELATIONSHIP
LYLE E. SHELDON AND JOSEPH E. HOFFMAN III ARE OFFICERS IN THE SAME BUSINESS ENTITIES. THE SAME BUSINESS ENTITIES ARE THE FOR-PROFT CORPORATIONS OR PARTNERSHIPS THAT ARE RELATED TO THIS FILING ENTITY. PLEASE SEE FORM 990, SCHEDULE R.
PART VI, SECTION B, POLICIES, QUESTION 11B
ORGANIZATIONAL REVIEW OF FORM 990
THE BOARD OF UPPER CHESAPEAKE HEALTH SYSTEM, INC. ("HEALTH SYSTEM") HAS ASSIGNED THE EXECUTIVE COMMITTEE OF THE HEALTH SYSTEM'S BOARD TO REVIEW AND APPROVE ALL CONTENTS OF FORM 990 ON BEHALF OF THE BOARDS OF HEALTH SYSTEM AND ALL OF HEALTH SYSTEM'S TAX-EXEMPT AFFILIATES. IN TURN, ONCE THE FORM 990 HAS BEEN APPROVED BY HEALTH SYSTEM'S EXECUTIVE COMMITTEE, A FINAL VERSION OF THE FORM 990 WILL BE MADE AVAILABLE TO ALL BOARD MEMBERS OF HEALTH SYSTEM AND HEALTH SYSTEM'S TAX-EXEMPT AFFILIATES. FORMAL NOTIFICATION OF THE FINAL AND APPROVED FORM 990 FOR HEALTH SYSTEM AND EACH OF HEALTH SYSTEM'S AFFILIATES AS WELL AS ITS AVAILABILITY WILL BE COMMUNICATED TO THE APPLICABLE BOARD MEMBERS ON OR BEFORE THE FILING OF THE FORM 990.
PART VI, SECTION B, POLICIES, QUESTION 12C
CONFLICT OF INTEREST POLICY
The organization's written conflict of interest policy covers the following individuals: Directors, Principal Officers, and Senior Management. Furthermore, the policy extends to the family members (per Internal Revenue Service definition) of such Directors, Principal Officers, and Senior Management. The Board of Directors and any committee considering a contract, transaction or arrangement to which a known or potential conflict of interest relates, determines whether a conflict exists. Actual conflicts are reviewed by the Chairman of the Board. An individual with a known or potential conflict of interest must refrain from participating in, or acting on, the decision on any matter in which a conflict of interest, or even the appearance of such a conflict of interest, is present with respect to such individual and will remove himself or herself from any meeting or deliberations on the matter.
PART VI, SECTION B, POLICIES, QUESTION 15
PROCESS FOR DETERMINING COMPENSATION
The executive compensation committee of the board of directors approves compensation for the Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, and all key employees. The executive compensation committee utilizes but is not limited to the following resources in evaluating and establishing reasonable compensation: independent compensation consultants, compensation surveys and compensation studies. This organization and its tax-exempt affiliates strive to maintain an arm's length relationship between itself and its employees. It is the goal of the executive compensation committee to ensure that total compensation (compensation and benefits) paid to its employees is fair and reasonable. Finally, the process of setting and approving such compensation is performed annually by the board's executive compensation committee.
PART VI, SECTION C, DISCLOSURE, QUESTION 19
DOCUMENTS AVAILABLE TO THE PUBLIC
THE ORGANIZATION WILL MAKE THE FOLLOWING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST: ARTICLES OF INCORPORATION, BYLAWS, AND CONFLICT OF INTEREST POLICY.
PART VII, SECTION A, PART I
AVERAGE HOURS PER WEEK
The following chart details the filing organization's board of directors members and officers who are also board of directors members and officers of related exempt organizations and the hours spent per week on duties for those related exempt organizations. The chart does not reflect hours spent per week on duties for any related for-profit entities. The hours reflected in Part VII, Section A, Column B are only the average hours per week for this filing organization. UCF UCMC UCMS UCP UCHC HMH HH UCRHH LYLE E. SHELDON 1 5 1 1 .50 5 1 .50 PRESIDENT/CEO JOSEPH E. HOFFMAN 1 5 1 1 1 5 - 1 SENIOR VP/CFO UCF UCMC UCMS UCP UCHC HMH HH UCRHH E. SCOTT CONOVER - 5 1 - - - - - SENIOR VP/GENERAL COUNSEL MARGARET M. VAUGHAN - 5 1 - - - - - SENIOR VP/CHIEF MEDICAL OFFICER KENNETH D. KOZEL 1 5 1 1 1 5 - - SENIOR VP/COO DEAN C. KASTER - 5 - - - 5 - - SENIOR VP/CORPORATE STRATEGY/PLANNING TONI M. SHIVERY - 5 - - - 5 - - VP/HUMAN RESOURCES UCF - UPPER CHESAPEAKE HEALTH FOUNDATION UCMC - UPPER CHESAPEAKE MEDICAL CENTER UCMS - UPPER CHESAPEAKE MEDICAL SERVICES UCP - UPPER CHESAPEAKE PROPERTIES UCHC - UPPER CHESAPEAKE/ST. JOES HOME CARE HMH - HARFORD MEMORIAL HOSPITAL HH - HEALTHY HARFORD UCRHH - UPPER CHESAPEAKE RESIDENTAL HOSPICE HOUSE
PART III, LINE 4
SIGNIFICANT PROGRAM SERVICE ACCOMPLISHMENTS FOR 2010
Community Outreach In 2010, HealthLink had approximately 22,350 community-wide adult contacts through their screening and education programs, flu vaccination clinics, support groups and HealthLink Primary Care Clinic visits. Approximately 5,449 of these contacts were for health screenings (blood pressure, body fat, cholesterol, osteoporosis, stroke, sleep, diabetes risk assessments, foot and eye screenings, and cancer screenings). An additional 3,890 contacts were realized through the HealthLink Primary Care Clinic. Over 2,000 influenza vaccinations were administered countywide. In addition to influenza vaccinations, Community Outreach provided an additional 56 H1N1 vaccinations. Community Outreach also provided local businesses with employee health screenings and vaccinations totaling 469 encounters. And more than 6,000 Harford County children received health education from Upper Chesapeake Community Outreach. Senior Center Programs - In addition to Community Health holding monthly blood pressure screenings at all five senior centers, Spring Health Carnivals were held at each center. The focus was on general health and well-being as well as staying active. Health screenings and physical activities were provided in a carnival atmosphere by Community Outreach. Approximately 200 seniors participated in one of the carnivals. Children's Programs - A total of 887 children were involved with our Glo Germ Program. This is a program that emphasizes how infection is spread and the importance of good hand washing habits. - Approximately 2,070 children were exposed to our "KATU" (Kids Against Tobacco Use) program and new Smoking Out the Truth. These programs teach children, adolescents, and teens about the dangers associated with tobacco use. "Toxic Soup" is a program that addresses the effects of secondhand smoke, which is a program included at times. - Approximately 219 children attended our Teddy Bear Clinics. This is a program that familiarizes children with the hospital experience. - "Be Smart about Body Art" was developed in 2007. It educates teens about the potential dangers associated with body piercing and tattooing. This program has been very successful with over 393 teens being educated in 2010. - "How Sweet It Is" was a new interactive program developed this year. The program educates children and adults on the sugar content in many of their favorite drinks including juice boxes, sports drinks, soda, flavored water, and popular coffee drinks. - Over 275 underserved children were fitted and given a bike helmet through HealthLink events in 2010. More than 6,000 Harford County children participated in one of the above listed children's programs in 2010.
VACCINES
Community Outreach administered approximately 2,000 community flu vaccinations and an additional 56 H1N1 vaccinations. "Dining with Docs" Lectures In 2010, "Dining with Docs" community lectures were held at both Upper Chesapeake Medical Center and Harford Memorial. A total of 138 community residents attended the lectures. 1N2N3N Cancer Event Free cancer screenings were offered at a half day Countywide Cancer event. Over eight County Agencies partnered with Community Outreach to provide cancer education and screenings to more than 178 county residents. The event was held at Harford Community College. The keynote speaker was Jayne Miller from Channel 11 and three of Upper Chesapeake Physicians provided lectures on cancer screenings, environmental effects and cancer, as well as the importance of taking time for you. HealthLink Community Wellness Center In 2010, the HealthLink Community Wellness Center, which operates from the HL Medical Mobile Van, had 160 residents participate in one of the available health screenings offered throughout the year. A third location at Cardiff Shop Rite was added mid-year. Primary Care Clinic The HealthLink Primary Care Clinic (PCC) provided primary care on a sliding fee scale to low income adults age 19 and above who are uninsured or underinsured and meet specific income criteria. In 2010, the PCC had approximately 1,500 established patients and a total of 3,890 patient encounters, up from 3,498 patient visits in 2009. HealthLink Call Center -In 2010, our HealthLink Call Center handled approximately 7,500 calls. This included almost 1,300 physician referral and 2,600 service calls. A new Call Center program and software, ECHO, was installed in 2010. - The "flu HOTLINE" was reinstated to keep the community better informed about the locations and times that flu clinics were being held throughout the county. As new information became available or changed, the recording on the HOTLINE was updated so that residents could get accurate information. Support Groups Two HealthLink RNs facilitate countywide support groups:chd stroke and diabetes. Both groups meet monthly; the stroke group meets at UCMC and the diabetes group meets at the Aberdeen Senior Center. The stroke group averages 12 participants per meeting (144 participants per year) and the diabetes group averages 17 participants per meeting (204 participants per year). HealthLink and Community Health Improvement Coalitions and Committees - Harford County School Health Board - Harford County Tobacco Coalition - Harford County Cancer Coalition - Harford County Highway Safety Committee - Office on Aging Advisory Board - Harford County Homeless Advisory Board
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.