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
PRIME CARE INC
Employer identification number
22-2759566
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)
(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 support?
Yes
No
Yes
No
Yes
No
Total
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.") .
287,754
196,117
21,296
24,428
24,518
554,113
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......
4,769,269
5,029,044
5,064,657
4,988,399
4,492,221
24,343,590
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.
5,057,023
5,225,161
5,085,953
5,012,827
4,516,739
24,897,703
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
24,897,703
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...
5,057,023
5,225,161
5,085,953
5,012,827
4,516,739
24,897,703
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
823,117
563,093
554,320
346,953
49,045
2,336,528
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
823,117
563,093
554,320
346,953
49,045
2,336,528
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.)
4,877
38,774
27,045
19,233
89,929
13
Total support (Add lines 9, 10c, 11 and 12.).
5,880,140
5,793,131
5,679,047
5,386,825
4,585,017
27,324,160
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
91.120 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
90.860 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
8.550 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
9.190 %
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, PART II, LINE 12, EXPLANATION OF OTHER INCOME: BAD DEBT RECOVERY OTHER REVENUE EXPENSE REIMBURSEMENT
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
PRIME CARE INC
Employer identification number
22-2759566
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE 2010 FORM 990 FILINGS FOR NORTH JERSEY HEALTH CARE CORPORATION ("NJHCC") AND ALL SUBSIDIARIES, INCLUDING PRIME CARE, WERE PREPARED BY THE FINANCE DEPARTMENT WITH THE ASSISTANCE OF NJHCC TAX ADVISORS. THE COMPLETED FILINGS WERE REVIEWED BY NJHCC'S CHIEF OPERATING OFFICER AND CHIEF FINANCIAL OFFICER. UPON FINALIZATION OF THE FORM 990, COPIES WERE MADE AVAILABLE TO BOARD MEMBERS. FORM 990 IS FILED WITH THE IRS AFTER THIS REVIEW PROCESS.
FORM 990, PART VI, SECTION B, LINE 12C
EACH "INTERESTED PERSON" OF PRIME CARE, INC. SHALL ANNUALLY SIGN THE NJHCC CONFLICT OF INTEREST DISCLOSURE STATEMENT (FORM #1885C) WHICH AFFIRMS THAT SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY OR THE NJHCC BY-LAWS, B. HAS READ AND UNDERSTANDS THE POLICY, C. HAS AGREED TO COMPLY WITH THE POLICY, AND D. UNDERSTANDS THAT NJHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES UNDER IRC SECTION 501(C)(3) OR 501(C)(4) OF THE INTERNAL REVENUE CODE. ON THE CONFLICT OF INTEREST DISCLOSURE STATEMENT, ALL "INTERESTED PERSONS" MUST DETAIL ALL EXISTING OR POTENTIAL CONFLICTS OF INTEREST AND FILE THE FORM WITH THE CHIEF COMPLIANCE OFFICER ANNUALLY. INTERIM DISCLOSURES SHALL ALSO BE REQUIRED AS CONFLICTS DEVELOP SUBSEQUENT TO THE ANNUAL DISCLOSURES. TO ENSURE THAT NJHCC OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEW SHALL BE CONDUCTED BY THE CHIEF COMPLIANCE OFFICER. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: A. WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULTS OF APPROPRIATE NEGOTIATIONS. B. WHETHER PHYSICIAN RECRUITMENT PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. C. WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER NJHCC'S CHARITABLE PURPOSES, AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. D. WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES AND THIRD PARTY PAYORS FURTHER NJHCC'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT.
FORM 990, PART VI, SECTION B, LINE 15
ALL OFFICERS ARE COMPENSATED BY A RELATED ORGANIZATION. THE ORGANIZATION REVIEWED AND DETERMINED THE TOTAL CASH COMPENSATION (CONSISTS OF BASE SALARY AND INCENTIVE AWARDS) OF THE PRESIDENT & CEO AND ALL EXECUTIVES (NAMELY, THE SVP-OPERATIONS/COO, VP-MEDICAL AFFAIRS/CMO, VP-FINANCE/CFO, VP-HR/CHIEF HR OFFICER AND CHIEF LEGAL OFFICER, VP-PATIENT CARE SERVICES/CNO, VP-FOUNDATION/CHIEF DEVELOPMENT OFFICER AND VP-MARKETING/BUSINESS DEVELOPMENT). THE ORGANIZATION ENGAGED INDEPENDENT CONSULTING FIRM, SULLIVAN COTTER AND ASSOCIATES, INC. TO PROVIDE GUIDANCE, ANALYSIS, RECOMMENDATIONS AND A REASONABLENESS OPINION. THIS PROCESS WAS LAST UNDERTAKEN IN 2008 FOR ALL OF THE AFOREMENTIONED EMPLOYEES. THE PROCESS INCLUDED SULLIVAN COTTER'S EVALUATION OF TOTAL CASH COMPENSATION FOR THESE EMPLOYEES BY USING COMPREHENSIVE COMPETITIVE MARKET DATA TO BENCHMARK SUCH COMPENSATION AGAINST OTHER HOSPITALS WITH SIMILAR NET REVENUE, COMPLEXITY, SCOPE, NON-PROFIT STATUS AND SIMILAR POSITIONS. MARKET DATA USED INCLUDES BOTH REGIONAL AND NATIONAL DATA. SULLIVAN COTTER DOCUMENTS ITS FINDINGS AND DELIVERS A WRITTEN REPORT AND OPINION TO THE ORGANIZATION. SULLIVAN COTTER'S FINDINGS AND RECOMMENDATIONS ARE REVIEWED BY THE EXECUTIVE COMPENSATION SUBCOMMITTEE OF THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS OF THE ORGANIZATION WHOSE REVIEW VIA ANALYSIS AND DELIBERATION IS DOCUMENTED IN THE MINUTE(S) OF ITS MEETINGS REGARDING SAME. UPON RECOMMENDATION OF THE EXECUTIVE COMPENSATION SUBCOMMITTEE OF THE GOVERNANCE COMMITTEE, THE FINDINGS AND RECOMMENDATIONS ARE ULTIMATELY REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS OF THE ORGANIZATION. THE BOARD'S FINDINGS AND DETERMINATIONS ARE DOCUMENTED IN THE MINUTES OF ITS MEETING(S) REGARDING SAME.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
AVERAGE HOURS PER WEEK
FORM 990, PART VII
AVERAGE HOURS PER WEEK LISTED IN PART VII ARE FOR THIS LEGAL ENTITY ONLY. BOARD MEMBERS AND OFFICERS ALSO DEVOTE TIME TO THE RELATED ORGANIZATIONS LISTED ON SCHEDULE R. TOTAL AVERAGE HOURS PER WEEK FOR ALL RELATED ORGANIZATIONS ARE AS FOLLOWS: BOARD MEMBERS - 5.8 HOURS PER WEEK PRESIDENT & CEO THOMAS J. SENKER - 42.5 HOURS PER WEEK COO SEAN O'ROURKE - 42.5 HOURS PER WEEK CFO DAVID RIKKOLA - 42.5 HOURS PER WEEK
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.