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
St Vincent Medical Group
Employer identification number
71-0830696
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.") .
292,085
126,212
418,297
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......
16,366,314
17,810,762
18,871,824
19,890,749
23,598,884
96,538,533
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.
16,366,314
17,810,762
18,871,824
20,182,834
23,725,096
96,956,830
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.)
96,956,830
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...
16,366,314
17,810,762
18,871,824
20,182,834
23,725,096
96,956,830
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.).
16,366,314
17,810,762
18,871,824
20,182,834
23,725,096
96,956,830
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
100.000 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
100.000 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0 %
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
St Vincent Medical Group
Employer identification number
71-0830696
Identifier
Return Reference
Explanation
DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS
Form 990, Part III, Q. 4a
St. Vincent Medical Group (SVMG) is an Arkansas nonprofit corporation that was created to provide medical services in the Little Rock, Arkansas metropolitan area. SVMG owns and operates physician clinics and related facilities and engages in activities designed to promote the health care needs of the community, including the provision of health care services by physicians and other health care professionals. SVMG currently provides physician services at twenty-one clinic locations and three hospital locations through sixty-two physician employees. SVMG provides a broad range of professional medical services at its clinics of the type normally provided at outpatient clinics. These clinics provide the health care services of non-physician professionals, including a nurse practitioner and nurses. SVMG also provides ancillary services, including radiology (including screening mammography, bone densitometry scanning, and general extremity and chest X-ray), CLIA-waived laboratory testing, treadmill stress testing, EKG, pulse oximetry, audiometry, physical therapy, injection and ultrasound services. SVMG provides medical care services on a nondiscriminatory basis to all persons in the community able to pay the cost thereof either directly or through third party reimbursement. SVMG participates in the Medicare and Medicaid programs in a nondiscriminatory manner. In addition, SVMG provides health care services to all individuals regardless of ability to pay, in accordance with SVMG's charity care policy. SVMG also provides medical care services on a nondiscriminatory basis to all persons in the community that are able to pay the cost thereof either directly or through third party reimbursement. In addition, SVMG requires each employed physician to cooperate with the community service activities consistent with furtherance of SVMG's charitable mission, including the physician's participation in community health and wellness education, community service activities and treatment of indigent and charity care patients. SVMG's sole corporate member is St. Vincent Infirmary Medical Center (SVIMC), an Arkansas nonprofit corporation that is exempt from Federal income tax as an organization described under 501 (c)(3) of the internal revenue code.
MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, Q.6
ACCORDING TO ST. VINCENT MEDICAL GROUP'S ARTICLES OF INCORPORATION, THE ENTITY'S SOLE MEMBER IS ST. VINCENT INFIRMARY MEDICAL CENTER D/B/A ST. VINCENT HEALTH SYSTEM, AN ARKANSAS NONPROFIT CORPORATION.
ELECTION OF BOARD MEMBERS
FORM 990, PART VI, Q.7A
ACCORDING TO THE ORGANIZATION'S ARTICLES OF INCORPORATION, THE RIGHT TO SELECT THE DIRECTORS OF THE CORPORATION IS RESERVED TO THE SOLE CORPORATE MEMBER. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT DIRECTORS AS NEEDED TO FILL EXPIRED TERMS OR VACANCIES, AND MAY REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS.
GOVERNING POWERS
FORM 990, PART VI, Q.7B
St. Vincent Medical Group's (SVMG) corporate member is St. Vincent Infirmary Medical Center d/b/a st. Vincent health system (SVHS). Pursuant to Section 5.4 of the organization's bylaws, both St. Vincent Health System and Catholic Health Initiatives (CHI) (SVHS's sole corporate member) have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the SVHS Board: - THE REMOVAL, WITH OR WITHOUT CAUSE, OF MEMBERS OF THE SVMG BOARD - ANY CHANGE IN MISSION OR PHILOSOPHY OF SVMG - ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS OF SVMG - THE INCURRENCE OF DEBT IN EXCESS OF THRESHOLDS AND WITHIN THE TIME LIMITS ESTABLISHED FROM TIME TO TIME BY SVHS - ANY JOINT VENTURE TO WHICH SVMG IS A PARTY - THE CREATION OF A NEW CORPORATION, PARTNERSHIP, OR LIMITED LIABILITY COMPANY BY SVMG - ANY MERGER OR CONSOLIDATION TO WHICH SVMG IS A PARTY - THE SALE OR DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF SVMG - THE ADOPTION OF LONG RANGE AND STRATEGIC PLANS - THE ADOPTION OF OPERATING AND CAPITAL BUDGETS - ANY VARIATION FROM PREVIOUSLY APPROVED OPERATING AND CAPITAL BUDGETS, IN EXCESS OF THRESHOLDS ESTABLISHED BY SVHS - THE RIGHT TO SELECT DIRECTORS OF SVHS IN ADDITION, PURSUANT TO SECTION 5.4.3 OF THE ORGANIZATION'S BYLAWS, CHI SHALL HAVE THE POWER TO TRANSFER ASSETS OF SVMG OR TO REQUIRE SVMG TO TRANSFER ASSETS TO CHI, TO THE EXTENT NECESSARY TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO PROVIDE FOR PAYMENT OF ALL INDEBTEDNESS OF CHI OR AN ENTITY CONTROLLED BY, CONTROLLING, OR UNDER COMMON CONTROL OF CHI, ISSUED OR INCURRED BY OR ON BEHALF OF CHI OR A CHI AFFILIATE IN FURTHERANCE OF CHI'S GOALS AND OBJECTIVES. Pursuant to Section 5.5.2 of the organization's bylaws, SVHS or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate.
PROCESS USED TO REVIEW FORM 990
FORM 990, PART VI, Q.11B
The CFO is responsible for reviewing the final tax return prepared by the CHI Tax Department. After the return has been reviewed, a copy is presented and reviewed at the Finance Committee Meeting and Board Meeting. Any questions or discrepancies are resolved prior to filing the return. The tax department then files the return with the appropriate federal and state agencies, making any-nonsubtantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
PROCEDURES FOR MONITORING AND ENFORCING COI POLICY
FORM 990, PART VI, Q. 12C
St. Vincent Medical Group has adopted the conflict of interest (COI) POLICY OF ITS sole corporate member, ST. VINCENT HEALTH SYSTEM (SVHS).The organization follows these guidelines to monitor and enforce its COI policy: St. Vincent Health System employees shall not accept any gifts, favors or hospitality that might influence or be interpreted as influencing their decision making or other actions affecting St. Vincent. St. Vincent Health System employees should not accept outside employment or engage in business activities which create a conflict of interest with their employment status or which hinder the employee's ability to perform their job assignments. Employees in management are required to inform their Executive of work being performed outside of St. Vincent. St. Vincent Health System will not hire, assign, or transfer immediate relatives of present employees to work in the same department at the same physical location. No person shall be employed, retained in or transferred to a position, which is directly or indirectly supervised by an immediate relative. Immediate relatives are spouses, spousal equivalents, parents, mothers-in-law, fathers-in-law, sisters, brothers, sisters-in-law, brothers-in-law, children, daughters-in-law, sons-in-law, first cousins, aunts, uncles, grandparents, and grandchildren. St. Vincent Health System created a compliance committee to review all reported activity that may violate established policy and procedures. Additionally, a hotline has been established for any employee to report possible compliance violations. The Conflict of Interest policy covers all individuals within SVHS. It is intended to concentrate on employees at the level that they can use their work knowledge for personal gain. This is generally any management personnel. Each person in a management position is required to complete an annual conflict of interest statement. This statement inquires to any possible conflict of interest and informs the employee of the COI policy. Actual conflicts are reviewed by the Corporate Responsibility Officer. If the conflict cannot be resolved or determined at that level, the CRO discusses with the CEO.
PROCESS FOR DETERMINING CEO COMPENSATION
FORM 990, PART VI, Q.15A
The organization's CEO's compensation is paid by CHI. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September, 2011. In addition, in December 2009, hay group completed a comprehensive review of all positions at the level of vice president and above to determine and validate appropriate compensation levels.
PROCESS USED TO DETERMINE OTHER OFFICER/KEY EMPLOYEE COMPENSATION
FORM 990, PART VI, Q. 15B
St. Vincent Medical Group does not compensate any officers, directors, trustees or key employees. All compensation paid to these individuals is done so by related organizations. For those top management officials that St. Vincent Medical Group does compensate, a Compensation Committee, comprised of members of the Board of Directors, reviews all executive team member salaries. All salary levels and increases are compared to industry standards and guidelines for appropriateness and compliance with St. Vincent Medical Group's compensation philosophy.
GOVERNING DOCUMENTS - COI POLICY - FINANCIAL STATEMENTS AVAILABLE
FORM 990, PART VI, Q.19
THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG. The organization's governing documents and conflict of interest policy are available upon request from the administration department. In addition, the governing documents are available from the Arkansas Secretary of State.
ESTIMATE OF HOURS
FORM 990, PART VII
COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR PER WEEK EMPLOYEES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.