Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2010 and ending 09-30-2011
BCheck if applicable:
CName of organization
CHARTERCARE HEALTH PARTNERS
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
825 CHALKSTONE AVENUE
 
Room/suite
City or town, state or country, and ZIP + 4
PROVIDENCE, RI02908
D Employer identification number

26-4235815
E Telephone number

G Gross receipts $ 14,803,510
F Name and address of principal officer:
KENNETH BELCHER
825 CHALKSTONE AVE
PROVIDENCE,RI02908
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHARTERCARE.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2009
M State of legal domicile: RI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE MISSION OF CHARTERCARE HEALTH PARTNERS IS TO PROVIDE HIGH QUALITY, PATIENT-FOCUSED, AND ACCESSIBLE CARE THROUGH COLLABORATION AMONG PARTNERS, MEDICAL STAFF, AND EMPLOYEES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 17
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 0
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 483,090
9 Program service revenue (Part VIII, line 2g) ......... 5,096,048 14,320,004
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 63
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 353
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 5,096,048 14,803,510
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,799,362 13,772,436
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 8,040
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet68,344    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,296,686 600,196
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 5,096,048 14,380,672
19 Revenue less expenses. Subtract line 18 from line 12......   422,838
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 232,067 2,141,600
21 Total liabilities (Part X, line 26)............ 232,067 1,718,762
22 Net assets or fund balances. Subtract line 21 from line 20 .....   422,838
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: THE MISSION OF CHARTERCARE HEALTH PARTNERS IS TO PROVIDE HIGH QUALITY, PATIENT-FOCUSED, AND ACCESSIBLE CARE THROUGH COLLABORATION AMONG PARTNERS, MEDICAL STAFF, AND EMPLOYEES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 14,312,328 including grants of $   ) (Revenue $ 14,320,357 )
CHARTERCARE PROVIDES MANAGEMENT SERVICES TO ROGER WILLIAMS MEDICAL CENTER (RWMC), ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND (SJHSRI), ELMHURST EXTENDED CARE FACILITIES, INC. (ELMHURST), ROGER WILLIAMS MEDICAL ASSOCIATES (RWMA) AND OTHER AFFILIATES. RWMC IS A 220 BED ACUTE CARE GENERAL HOSPITAL PROVIDING HEALTHCARE SERVICES IN PROVIDENCE AND SURROUNDING COMMUNITIES. SJHSRI IS A 359 BED ACCUTE CARE INTEGRATED HEALTHCARE DELIVERY SYSTEM ESTABLISHED TO PROVIDE HEALTHCARE SERVICES IN NORTH PROVIDENCE, RI AND SURROUNDING COMMUNITIES. ELMHURST IS A 192 BED SKILLED NURSING HOME AND IMMEDICATE CARE FACILITY AND PROVIDER OF OTHER ELDER CARE SERVICES.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 14,312,328
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
No
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
17
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
Yes
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
KATHLEEN MOORE
200 HIGH SERVICE AVE
NORTH PROVIDENCE,RI02904
(401) 456-3322
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KENNETH H BELCHER
PRESIDENT AND CEO
 40.0 X   X       0 372,674 98,964
(2) CHRISTOPHER N CHIHLAS MD
DIRECTOR
 1.0 X           0 0 0
(3) LAURIE M LAUZON CLABO PHD RN
DIRECTOR
 1.0 X           0 0 0
(4) PETER F DEBLASIO JR MD
DIRECTOR
 1.0 X           0 0 0
(5) JOSEPH R DISTEFANO ESQ
DIRECTOR
 1.0 X           0 0 0
(6) ELAINE C JONES MD
DIRECTOR
 1.0 X           0 0 0
(7) DONALD C MCQUEEN
DIRECTOR
 1.0 X           0 0 0
(8) CHARLES E MAYNARD
DIRECTOR
 1.0 X           0 0 0
(9) MARSHALL RAUCCI JR
DIRECTOR
 1.0 X           0 0 0
(10) REVEREND TIMOTHY REILLY
DIRECTOR
 1.0 X           0 0 0
(11) DANIEL J RYAN CPA
VICE CHAIRMAN JAN 2011
 1.0 X           0 0 0
(12) EDWIN J SANTOS
CHAIRMAN
 1.0 X   X       0 0 0
(13) REV BRIAN J SHANLEY OP
DIRECTOR
 1.0 X           0 0 0
(14) SHERI L SMITH PHD
DIRECTOR
 1.0 X           0 0 0
(15) KEVIN P STILES
DIRECTOR
 1.0 X           0 0 0
(16) REV MSGR PAUL D THEROUX
VICE CHAIRMAN JAN 10-DEC 10
 1.0 X   X       0 0 0
(17) HONORABLE JOSEPH R WEISBERGER
DIRECTOR JAN 10-JUNE 11
 1.0 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) JOHN M FOGARTY- SJHSRI
COO JAN 10-OCT 10
 40.0 X   X       0 456,178 32,545
(19) MICHAEL CONKLIN JR
CFO/TREASURER
 40.0 X   X       0 191,801 20,295
(20) KIMBERLY O'CONNELL
VP LEGAL/SECRETARY
 40.0 X   X       0 214,497 49,498
(21) SUSAN CERRONE-ABELY
CIO
 40.0       X     0 197,605 57,782
(22) DARLENE SOUZA
VP HUMAN RESOURCES
 40.0       X     0 175,046 22,759
(23) JOANNE DOOLEY
VP CNO
 40.0       X     0 207,561 40,407
(24) OTIS BROWN
VP EXTERNAL AFFAIRS
 40.0         X   0 181,115 25,957
(25) CHRISTOPHER FERRARO
FORMER EXECUTIVE DIRECTOR
 40.0         X   0 188,612 25,046
(26) ADOZINDA KANE
EXECUTIVE DIRECTOR OF FINANCE
 40.0         X   0 243,526 78,239








1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 2,428,615 451,492
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Ikon Office Solutions Mngmt Servi
PO Box 534777
Atlanta,GA303534777 		Equipment Rental 147,557
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet1
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 475,890
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		7,200
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 483,090
Program Service Revenue Business Code
2a MANAGEMENT FEE REVENUE 561,000 14,320,004 14,320,004    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 14,320,004
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 63   0 63
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 0 0
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 0 0
b Less: cost or other basis and sales expenses    
c Gain or (loss) 0 0
d Net gain or (loss)..........MediumBullet 0      
8a Gross income from fundraising events (not including
$ 475,890
of contributions reported on line 1c). See Part IV, line 18 ...
a 0
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 0
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a PURCHASING REBATES   353 353    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 353
12 Total revenue. See Instructions....MediumBullet 14,803,510 14,320,357 0 63
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,434,732 1,434,732 0  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 9,083,620 9,083,620    
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 3,254,084 3,254,084    
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 53,500 53,500    
c Accounting ........... 18,852 18,852    
d Lobbying ........... 56,700 56,700    
e Professional fundraising. See Part IV, line 17.. 8,040 8,040
f Investment management fees ...... 0      
g Other .......... 120,000 120,000    
12 Advertising and promotion .... 34,715 34,715    
13 Office expenses ....... 14,239 14,239    
14 Information technology ...... 12,435 12,435    
15 Royalties .. 0      
16 Occupancy ........... 0      
17 Travel ............ 10 10    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 13,963 13,963    
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 28,103 28,103    
23 Insurance .............. 100,581 100,581    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEMBERSHIP DUES 750 750    
b PUBLIC RELATIONS 61,709 61,709    
c OTHER 84,639 24,335   60,304
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 14,380,672 14,312,328 0 68,344
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 439 1 90,317
2 Savings and temporary cash investments .......   2 307,491
3 Pledges and grants receivable, net .........   3 113,550
4 Accounts receivable, net .........   4  
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ............ 48,906 9 77,206
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 351,382
b Less: accumulated depreciation. ..... 10b 28,550 91,945 10c 322,832
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 90,777 15 1,230,204
16 Total assets. Add lines 1 through 15 (must equal line 34)... 232,067 16 2,141,600
Liabilities 17 Accounts payable and accrued expenses . 232,067 17 435,238
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D.....   25 1,283,524
26 Total liabilities. Add lines 17 through 25..... 232,067 26 1,718,762
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .....   27  
28 Temporarily restricted net assets .....   28 422,838
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 0 33 422,838
34 Total liabilities and net assets/fund balances ..... 232,067 34 2,141,600
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
14,803,510
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
14,380,672
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
422,838
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
0
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
 
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
422,838
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
 
No
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
 
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
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
f
g
(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
(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) ROGER WILLIAMS MEDICAL CENTER
  		050258959 03 Yes           0
(2) SAINT JOSEPH HEALTH SERVICES OF RI
  		050259026 03 Yes           0
(3) CHARTERCARE HEALTH PARTNERS FOUNDATION INC
  		260236669 07 Yes           0
Total                 0

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
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
CHARTERCARE HEALTH PARTNERS
  		Employer identification number

26-4235815
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
CHARTERCARE HEALTH PARTNERS
  		Employer identification number

26-4235815
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
CHARTERCARE HEALTH PARTNERS
  		Employer identification number

26-4235815
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
56,700
j
Total. lines 1c through 1i ...................................
56,700
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITY Part II-B LINE 1 CHARTERCARE HIRED ADVOCACY SOLUTIONS TO REPRESENT OUR INTERESTS AND ACHIEVE OUR LEGISLATIVE GOALS.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........ 475,890    
c Investment earnings or losses ... 47    
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		53,099    
f Administrative expenses ....      
g End of year balance ...... 422,838    
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet2.000 %
b
Permanent endowment: SchDMd Bullet0 %
c
Term endowment: SchDMd Bullet98.000 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................ 0 332,292 28,550 303,742
e Other ................. 0 19,090   19,090
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 322,832
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM RELATED PARTIES 131,018
(2) FLEX BENEFIT PLAN INVESTMENT 1,099,186







Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 1,230,204
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
RETIREMENT BENEFIT PAYABLE 1,283,524








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,283,524
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
INTENDED USES OF ENDOWMENT FUNDS FORM 990, SCHEDULE D, PART V, LINE 4 CHARTERCARE HEALTH PARTNERS RAISED ENDOWMENT FUNDS THROUGH THREE FUNDRAISING EVENTS IN FISCAL YEAR 2011: 2011 GOLF CLASSIC, 2011 GALA, AND THE 2011 ANNUAL CAMPAIGN. THE 2011 GOLF CLASSIC RAISED FUNDS FOR THE CHARTERCARE SYSTEM FOR THE PURPOSE OF CANCER CARE. THE 2011 GALA RAISED FUNDS FOR THE CHARTERCARE SYSTEM FOR THE PURPOSE OF ELDERCARE SERVICES. THE 2011 ANNUAL CAMPAIGN RAISED FUNDS FOR THE CHARTERCARE SYSTEM AT THE DONOR'S DISCRETION. AT SEPTEMBER 30, 2011, THE FUNDS HAD $197,743, $210,095, AND $15,000 RESPECTIVELY.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

CCHP 2011 GOLF
(event type) 		(b) Event #2

CCHP 2011 GALA
(event type) 		(c) Other Events

1
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 250,805 210,085 15,000 475,890
2 Less: Charitable
contributions . . . 		250,805 210,085 15,000 475,890
3 Gross income (line 1
minus line 2) . . . 		       
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses .        
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow  
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow  
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) KENNETH H BELCHER (i)
(ii)		 0
371,428 		0
0 		0
1,246 		0
35,000 		0
63,964 		0
471,638 		0
0
(2) JOHN M FOGARTY- SJHSRI (i)
(ii)		 0
284,431 		0
0 		0
171,747 		0
0 		0
32,545 		0
488,723 		0
0
(3) MICHAEL CONKLIN JR (i)
(ii)		 0
191,801 		0
0 		0
0 		0
0 		0
20,295 		0
212,096 		0
0
(4) KIMBERLY O'CONNELL (i)
(ii)		 0
214,128 		0
0 		0
369 		0
19,000 		0
30,498 		0
263,995 		0
16,336
(5) SUSAN CERRONE-ABELY (i)
(ii)		 0
196,925 		0
0 		0
680 		0
19,000 		0
38,782 		0
255,387 		0
0
(6) DARLENE SOUZA (i)
(ii)		 0
175,046 		0
0 		0
0 		0
0 		0
22,759 		0
197,805 		0
0
(7) OTIS BROWN (i)
(ii)		 0
181,115 		0
0 		0
0 		0
0 		0
25,957 		0
207,072 		0
0
(8) JOANNE DOOLEY (i)
(ii)		 0
207,561 		0
0 		0
0 		0
19,950 		0
20,457 		0
247,968 		0
0
(9) CHRISTOPHER FERRARO (i)
(ii)		 0
188,612 		0
0 		0
0 		0
0 		0
25,046 		0
213,658 		0
0
(10) ADOZINDA KANE (i)
(ii)		 0
242,838 		0
0 		0
688 		0
24,513 		0
53,726 		0
321,765 		0
0






Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
ESTABLISH COMPENSATION PART I, LINE 3 100% OF SALARIES FOR CHARTERCARE HEALTH PARTNERS EMPLOYEES ARE APPROPRIATELY CHARGED TO CHARTERCARE HEALTH PARTNERS USING A MANUAL PROCESS OF REMOVING THE SALARIES FROM EACH HOSPITAL AND RECORDING THEM ON CHARTERCARE. SALARIES AND BENEFITS ARE PAID BY CHARTERCARE HEALTH PARTNERS THROUGH ROGER WILLIAMS MEDICAL CENTER AND ST. JOSEPH HEALTH SERVICES OF RI. EMPLOYEE SALARIES FOR CALENDAR YEAR 2010 ARE DETERMINED UNDER THE COMPENSATION POLICIES OF CHARTERCARE HEALTH PARTNERS.
SEVERANCE PAYMENT PART I, LINE 4A JOHN M. FOGARTY RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $171,747.
NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATE IN A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN ESTABLISHED UNDER ROGER WILLIAMS MEDICAL CENTER AND RECEIVED THE FOLLOWING DISTRIBUTIONS UNDER THE 457(F) PLAN: KENNETH BELCHER - $0 KIMBERLY O'CONNELL - $16,336 JOANNE DOOLEY - $0 SUSAN CERRONE-ABELY - $0 ADOZINDA KANE - $0
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Identifier Return Reference Explanation
SIGNIFICANT CHANGES TO THE ORGANIZATION'S DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 ST JOSEPH HEALTH SERVICES FOUNDATION, INC. (SJ FOUNDATION): THE SJ FOUNDATION IS A NONPROFIT SOLE MEMBER OF SJHSRI. THE SJ FOUNDATION HAS BEEN LISTED IN THE OFFICIAL CATHOLIC DIRECTORY AND FROM THAT DERIVES ITS 501(C)3 STATUS AS AN EXEMPT ORGANIZATION WHOSE MISSION IS TO RAISE FUNDS FOR THE SPECIFIC PURPOSE OF SJHSRI. AUGUST 22, 2011, SJ FOUNDATION CHANGED ITS NAME TO CHARTERCARE HEALTH PARTNERS FOUNDATION INC (CCHP FOUNDATION), REMOVED ITSELF FROM THE OFFICIAL CATHOLIC DIRECTORY, AND BECAME A SUBSIDIARY OF CHARTERCARE HEALTH PARTNERS (CCHP). EFFECTIVE WITH THE CHANGE IN NAME, THE ARTICLES OF INCORPORATION WERE AMENDED. THE CCHP FOUNDATION IS A NOT-FOR-PROFIT CORPORATION WHOSE MISSION IS TO RAISE FUNDS FOR THE BENEFIT OF CCHP AND ITS AFFILIATES.
FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETION OF THE FORM 990 BEGINS WITH AN OPENING MEETING ATTENDED BY CHARTERCARE'S CONTROLLER AND KPMG LLP, AN INDEPENDENT TAX CONSULTANT. THE MEETING CONSISTS OF A REVIEW OF THE ORGANIZATIONAL STRUCTURE, SIGNIFICANT CHANGES IN OPERATIONS OR PROGRAM ACTIVITIES FROM THE PRIOR YEAR, AND OVERVIEW OF CHANGES IN THE FORM 990. THE FINANCE DEPARTMENT GATHERS THE REQUIRED INFORMATION AND POPULATES THE FORM 990 IN CONJUNCTION WITH KPMG LLP. ONCE COMPLETED, THE DRAFT FORM 990 IS REVIEWED WITH SENIOR MANAGEMENT TO ENSURE INDIVIDUALS ARE PROVIDED TIME TO REVIEW AND APPROVE THE FORM 990 PRIOR TO THE DEADLINE. AFTER THE INTERNAL REVIEW IS COMPLETED, THE FORM 990 IS PROVIDED TO CHARTERCARE'S FINANCE COMMITTEE FOR THEIR REVIEW AND COMMENTS. A MEETING IS HELD TO REVIEW THE FORM 990 AND DISCUSS ANY QUESTIONS AND COMMENTS. UPON FINANCE COMMITTEE APPROVAL, A FINAL COPY OF THE FORM 990 IS DISTRIBUTED TO EACH VOTING BOARD MEMBER AND FILED WITH THE TAXING AUTHORITY
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12 THE CONFLICT OF INTEREST POLICY INCLUDED IN THE BY-LAWS IS TO PROTECT THE CORPORATION'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR TRUSTEE OF THE CORPORATION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE OFFICERS, TRUSTEES, AND MEMBERS OF ANY COMMITTEES WITH BOARD-DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ON AN ANNUAL BASIS, EACH MEMBER OF THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND ALL RESPONSES ARE SUBMITTED AND REVIEWED BY LEGAL COUNSEL. ANY ACTUAL AND POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED WITH THE BOARD OF TRUSTEES.
COMPENSATION POLICY FORM 990, PART VI, SECTION B LINE 15 CHARTERCARE EMPLOYEE SALARIES AND BENEFITS ARE PAID BY ROGER WILLIAMS MEDICAL CENTER AND SAINT JOSEPH HEALTH SERVICES OF RI. EACH EMPLOYEE DEVOTES A PORTION OF HIS OR HER TIME TO VARIOUS CHARTERCARE AFFILIATES. SALARY EXPENSES ARE THEN APPROPRIATELY ALLOCATED AND CHARGED TO CHARTERCARE'S RELATED ENTITIES. EFFECTIVE FOR THE CALENDAR YEAR BEGINNING JANUARY 2010, CCHP ESTABLISHED A CHARTERCARE COMPENSATION POLICY AND CHARTERCARE EXECUTIVE INCENTIVE PLAN. EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT: THE DEVELOPMENT AND ADMINISTRATION OF THE EXECUTIVE COMPENSATION PROGRAM ARE GUIDED BY CHARTERCARE'S MISSION, STRATEGIC PLANS, AND STATUS AS A CHARITABLE TAX-EXEMPT ORGANIZATION AND THE FIDUCIARY RESPONSIBILITY OF ENSURING THAT COMPENSATION AND BENEFITS PAID TO EMPLOYEES ARE WITHIN THE FINANCIAL RESOURCES AVAILABLE, ARE REASONABLE AND COMMENSURATE WITH THE PRODUCTIVITY, SERVICES AND VALUE RECEIVED. THE FIDUCIARY RESPONSIBILITY IS TO COMPENSATE EXECUTIVES REASONABLY AND COMPETITIVELY WITHIN THE FINANCIAL RESOURCES OF THE ORGANIZATION AND COMMENSURATE WITH FAIR VALUE FOR SERVICES RECEIVED, IN ACCORDANCE WITH BOARD GOVERNANCE BEST PRACTICES AND APPLICABLE LAWS AND REGULATIONS. THE BOARD OF DIRECTORS OF CHARTERCARE INTENDS THAT ITS ANNUAL SALARY AND INCENTIVE COMPENSATION DECISIONS WILL BE MADE IN SUCH A WAY AS TO QUALIFY UNDER THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DEFINED BY SECTION 4958 OF THE INTERNAL REVENUE CODE ON INTERMEDIATE SANCTIONS. CONSISTENT WITH THE STATED COMMITMENTS BY CHARTERCARE AND/OR ITS AFFILIATES, COMPENSATION AND BENEFITS POLICIES, PROCESSES AND GUIDELINES ARE DESIGNED AND ADMINISTERED IN SUCH A WAY AS TO COMPLY WITH ALL LAWS AND TO PROVIDE FAIR TREATMENT FOR ALL EMPLOYEES REGARDLESS OF RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, AGE, DISABILITY OR ANY OTHER CATEGORY PROTECTED BY LAW. FACTORS DETERMINING INDIVIDUAL EXECUTIVES' SALARIES INCLUDE: SPECIFIC SKILL SETS OF THE EXECUTIVES SUCH AS EDUCATION, EXPERIENCE, SPECIALTY SKILLS AND COMPETENCIES RELATED TO EACH EXECUTIVE POSITION; THE SALARY RELATIONSHIP WITH SIMILARLY SITUATED EXECUTIVES IN COMPARABLE ORGANIZATIONS AND THE FINANCIAL STATUS OF THE INSTITUTION. THE BOARD HAS DELEGATED RESPONSIBILITY OF EXECUTIVE COMPENSATION REVIEW TO THE EXECUTIVE COMMITTEE. TOTAL CASH COMPENSATION (TCC): TOTAL CASH COMPENSATION CONSISTING OF BASE SALARY AND INCENTIVE COMPENSATION ARE COMPONENTS OF THE EXECUTIVE COMPENSATION PROGRAM THAT CHARTERCARE EXECUTIVE EMPLOYEES RECEIVE IN RETURN FOR THEIR WORK CONTRIBUTIONS AND ACCOMPLISHMENTS. TOTAL CASH COMPENSATION IS BASED ON EXECUTIVE PERFORMANCE, INCLUDING THE ACCOMPLISHMENT OF GOALS AND OBJECTIVES AS WELL AS THE MANNER IN WHICH THE WORK IS DONE. CHARTERCARE TARGETS TOTAL CASH COMPENSATION FOR ITS EXECUTIVES AT THE 50TH PERCENTILE OF COMPENSATION RANGES FOR SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS. CASH COMPENSATION FOR EXECUTIVES COVERED BY THIS OVERVIEW IS ADMINISTERED VIA TWO COMPENSATION PROGRAM COMPONENTS: BASE AND INCENTIVE COMPENSATION. THIS IS IN RECOGNITION THAT A PORTION OF EACH EXECUTIVE'S CASH COMPENSATION (INCENTIVE COMPENSATION) IS "AT RISK" BASED ON THE ACCOMPLISHMENT OF ORGANIZATIONAL AND INDIVIDUAL GOALS AND OBJECTIVES. TOTAL CASH COMPENSATION IS MADE UP OF TWO COMPONENTS: 1. BASE SALARY: TARGETED AT THE 5% BELOW MARKET SALARY MEDIAN (50TH PERCENTILE) FOR CHARTERCARE'S PEER GROUP. 2. INCENTIVE COMPENSATION: A PERCENTAGE OF BASE SALARY PROVIDES EXECUTIVES WITH AWARD OPPORTUNITIES OF TOTAL CASH COMPENSATION WITH TCC (BASE PLUS INCENTIVE COMPENSATION) TARGETED AT THE 50TH PERCENTILE OF THE TCC MARKET FOR CHARTERCARE'S PEER GROUP OR SURVEY MATCHES IN REPUTABLE PUBLISHED SURVEYS OF SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS. THE TERMS AND CONDITIONS OF THE INCENTIVE PLAN ARE DEFINED IN THE EXECUTIVE INCENTIVE PLAN COMPENSATION DOCUMENT. GOALS AND OBJECTIVES, THRESHOLD, TARGET, AND MAXIMUM PAYMENTS, METRICS AND WEIGHTING ARE ESTABLISHED TO OPTIMIZE PLAN INCENTIVES WHEN ORGANIZATIONAL OBJECTIVES ARE MET. DETIALS ARE OUTLINE IN THE EXECUTIVE INCENTIVE PLAN (EIP) DOCUMENT AND EACH EXECUTIVE'S PARTICIPANT GOALS & OBJECTIVES FORM FOR ANY GIVEN PLAN YEAR. BASE SALARY STRUCTURE AND SALARY ADMINISTRATION: CHARTERCARE AND/OR ITS AFFILIATES ESTABLISHED ITS EXECUTIVE SALARY STRUCTURE AND RANGES USING MARKET DATA FOR EXECUTIVE POSITIONS WITH COMPARABLE RESPONSIBILITIES AT LIKE ORGANIZATIONS UNDER LIKE CIRCUMSTANCES (THE "PEER GROUP"). CHARTERCARE AND/OR ITS AFFILIATES REGULARLY CONDUCTS A CUSTOM PEER GROUP STUDY CONDUCTED BY AN OUTSIDE FIRM AND OR ASSESSES COMPENSATION MARKET DATA FROM REPUTABLE, COMMERCIALLY-AVAILABLE SURVEYS PREPARED BY INDEPENDENT FIRMS. USING THE "MARKET PRICING" APPROACH, CHARTERCARE'S AND/OR ITS AFFILIATES EXECUTIVE SALARY RANGES ARE ESTABLISHED WITH SALARY RANGE MIDPOINTS POSITIONED APPROXIMATING THE 50TH PERCENTILE (MEDIAN) OF THE PEER GROUP MARKET DATA FOR BASE SALARIES. SINCE CHARTERCARE AND/OR ITS AFFILIATES SETS THE SALARY RANGE MIDPOINTS AT THE MARKET MEDIAN OF BASE SALARIES, IT STRIVES FOR INDIVIDUAL SALARIES TO BE MANAGED IN THE FOLLOWING MANNER: 1. NEWLY HIRED OR INEXPERIENCED EXECUTIVES WILL BE PAID BETWEEN THE MINIMUM AND MIDPOINT OF THEIR SALARY RANGES. 2. EXECUTIVES WHO CONSISTENTLY MEET THE EXPECTATIONS OF THEIR POSITION WILL BE PAID AT OR NEAR THE MIDPOINT OF THEIR SALARY RANGES. 3. EXECUTIVES WHO CONSISTENTLY EXCEED THE EXPECTATIONS OF THEIR POSITION WILL BE PAID BETWEEN THE MIDPOINT AND THE 75TH PERCENTILE OF THEIR SALARY RANGES. IN RARE CASES WHERE RECRUITMENT OF NEW EXECUTIVES DICTATES, AN EXECUTIVE MAY BE PAID BETWEEN THE 75TH PERCENTILE AND MAXIMUM OF HIS OR HER SALARY RANGE. IN SUCH CASES, JUSTIFICATION FOR ADDITIONAL INCENTIVE COMPENSATION PAYOUT SHALL BE REVIEWED IN ADVANCE BY THE BOARD AND MAINTAINED IN THE OFFICIAL RECORDS OF THE EXECUTIVE COMMITTEE OF CHARTERCARE FUNCTIONING AS THE COMPENSATION COMMITTEE. NO EXECUTIVE IS PAID ABOVE THE MAXIMUM OF THE PAY RANGE. GIVEN PRESENT STRATEGIC PLANS BY CHARTERCARE TO OPERATIONALIZE THE INTEGRATION OF ROGER WILLIAMS MEDICAL CENTER AND ST. JOSEPH HEALTH SERVICES AND EXPAND AND DIVERSIFY ITS SERVICES, THE ORGANIZATION RECOGNIZES THAT RETENTION AND RECRUITMENT OF PERSONNEL MAY NEED TO OCCUR IN THE BROADER HEALTH CARE SERVICES. THE BOARD OF DIRECTORS OF CHARTERCARE INTENDS THAT ITS ANNUAL SALARY AND INCENTIVE COMPENSATION DECISIONS WILL BE MADE IN SUCH A WAY AS TO QUALIFY UNDER THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DEFINED BY SECTION 4958 OF THE INTERNAL REVENUE CODE ON INTERMEDIATE SANCTIONS. INCENTIVE COMPENSATION PLAN AND ADMINISTRATION: INCENTIVE COMPENSATION IS BASED ON AN ANALYSIS OF COMPETITIVE PRACTICE USING THE SAME RESEARCH METHODOLOGY BY AN INDEPENDENT COMPENSATION CONSULTANT AS IN STUDYING BASE SALARIES IN ACCORDANCE WITH BEST PRACTICES AND THE REQUIREMENTS OF THE GUIDELINES ON INTERMEDIATE SANCTIONS. PLAN SPECIFICS ARE CONTAINED IN TWO DOCUMENTS: THE "MASTER CHARTERCARE AND/OR ITS AFFILIATES EXECUTIVE PLAN COMPENSATION" AND "ANNUAL CHARTERCARE AND/OR ITS AFFILIATES EXECUTIVE PLAN COMPENSATION". FURTHER, THE PRIMARY FACTORS WHICH WILL DEFINE ORGANIZATIONAL OR TEAM GOALS AND OBJECTIVES WILL BE: ADMINISTRATIVE AND ORGANIZATIONAL RATIONALIZATION, SERVICE LINE INTEGRATION, AND CLINICAL OPTIMIZATION. INCENTIVE PLAN GOALS WILL BE STRUCTURED TO PROVIDE REWARDS FOR ACHIEVING THE ECONOMIES, EFFICIENCIES, AND IMPROVED QUALITY AND SERVICE THAT THE CREATION OF CHARTERCARE PROMISES. THERE IS AN EXPLICIT LINKAGE BETWEEN OUR SUCCESS IN IMPLEMENTING STRATEGIC AND OPERATING PLANS WITH THE PAYMENT OF INCENTIVE COMPENSATION. TOTAL REMUNERATION: TOTAL REMUNERATION IS DEFINED AS TOTAL CASH COMPENSATION PLUS STANDARD BENEFITS, SUPPLEMENTAL EXECUTIVE BENEFITS, AND PREREQUISITES. CHARTERCARE TARGETS TOTAL REMUNERATION FOR ITS EXECUTIVES AT THE 50TH PERCENTILE OF COMPENSATION RANGES FOR SIMILAR POSITIONS IN COMPARABLE ORGANIZATIONS. THE EXECUTIVE COMMITTEE, FUNCTIONING AS THE EXECUTIVE COMMITTEE OF THE BOARD, IS CHARTERED WITH MAKING DECISIONS REGARDING TOTAL REMUNERATION IN ACCORDANCE WITH QUALIFYING UNDER THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DEFINED BY SECTION 4958 OF THE INTERNAL REVENUE CODE ON INTERMEDIATE SANCTIONS.
EXECUTIVE INCENTIVE PLAN (EIP) SUMMARY: GOALS AND OBJECTIVES OF THE 2010 EIP: TO PROVIDE INCENTIVE COMPENSATION TO CHARTERCARE AND/OR ITS AFFILIATES EXECUTIVES, AS PROVIDED IN THE "MASTER EXECUTIVE INCENTIVE COMPENSATION PLAN" DOCUMENT, TO REWARD THE ACHIEVEMENT OF SPECIFIC SHORT- AND LONG-TERM SYSTEM OBJECTIVES AND STRATEGIES AS DOCUMENTED IN THE OPERATING PLAN AND DEPARTMENTAL IMPLEMENTATION TEAM OBJECTIVES. THE PRIMARY FACTORS WHICH WILL DEFINE ORGANIZATIONAL AND TEAM GOALS/OBJECTIVES WILL BE FOCUSED ON ACHIEVING KEY STRATEGIC INITIATIVES INCLUDING, BUT ARE NOT LIMITED TO, PATIENT CARE QUALITY AND SAFETY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, PHYSICIAN SATISFACTION, FINANCIAL PERFORMANCE, OPERATING EFFICIENCIES, SERVICE-LINE INTEGRATION, CLINICAL OPTIMIZATION AND VOLUME GROWTH. THE ORGANIZATIONAL FINANCIAL GOAL(S) WILL IDENTIFY MEASURABLE SAVINGS FOR THE PLAN YEAR SUCH AS OPERATING MARGIN, GROSS MARGINS, NET OPERATING INCOME, REVENUE GROWTH, NET INCOME, AND RETURN ON ASSETS. ALTHOUGH INDIVIDUAL OBJECTIVES WILL BE ASSIGNED TO DRIVE ORGANIZATIONAL ACHIEVEMENT, NO PAYMENTS ARE DUE UNLESS THE ABOVE REFERENCED FINANCIAL GOALS ARE ACHIEVED. THIS INCENTIVE PLAN PROVISION IS CALLED A "TRIGGER". PLAN YEAR DEFINITION: JANUARY 1ST THROUGH DECEMBER 31ST OF ANY GIVEN YEAR. ELIGIBLE EMPLOYEES: THE FOLLOWING EXECUTIVE POSITIONS ARE ELIGIBLE TO PARTICIPATE IN THE PLAN AND AT THE TARGET AND MAXIMUM AWARDS SPECIFIED BELOW: PLAN PARTICIPANT INCENTIVE TARGET AND MAXIMUM AWARDS (% OF ANNUAL BASE SALARY) PRESIDENT AND CHIEF EXECUTIVE OFFICER TARGET AWARD 20% MAXIMUM AWARD 25% SENIOR VICE PRESIDENT, CHIEF FINANCIAL OFFICER TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT CHIEF INFORMATION OFFICER TARGET AWARD 20% MAXIMUM AWARD 25% SENIOR VICE PRESIDENT & GENERAL COUNSEL TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT, MEDICAL AFFAIRS & CHIEF MEDICAL OFFICER TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT, PLANNING & NETWORK DEVELOPMENT TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT, EXTERNAL AFFAIRS TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT, HUMAN RESOURCES TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT, EXTENDED CARE SERVICES TARGET AWARD 20% MAXIMUM AWARD 25% VICE PRESIDENT PATIENT SERVICES, CHIEF NURSING OFFICER TARGET AWARD 20% MAXIMUM AWARD 25% ELIGIBLE EXECUTIVES WILL BE PROVIDED WITH A COPY OF THE EXECUTIVE INCENTIVE PLAN (EIP) AND "MASTER EXECUTIVE INCENTIVE COMPENSATION PLAN" DOCUMENTS PRIOR TO ANY GIVEN PLAN YEAR. FUNDING: THE PLAN MAY BEGIN TO FUND AT 85% OF FINANCIAL TARGET ACHIEVEMENT. AT THE SOLE DISCRETION OF THE BOARD, A THRESHOLD BONUS PAYMENT MAY BE APPROVED USING THE FOLLOWING FUNDING TRIGGERS AND AWARD PERCENTS: SYSTEM PERFORMANCE (GOAL ATTAINMENT) 85-95% PLAN FUNDING LEVEL 65% SYSTEM PERFORMANCE (GOAL ATTAINMENT) 95-99% PLAN FUNDING LEVEL 75% SYSTEM PERFORMANCE (GOAL ATTAINMENT) 100-104% PLAN FUNDING LEVEL 100% SYSTEM PERFORMANCE (GOAL ATTAINMENT) 105-109% PLAN FUNDING LEVEL 105% SYSTEM PERFORMANCE (GOAL ATTAINMENT) >110% PLAN FUNDING LEVEL 110% THE BOARD OF DIRECTORS WILL MAKE THE FUNDING LEVEL AVAILABLE TO THE PLAN UPON APPROVAL. PLAN METRICS: EACH PARTICIPANT WILL BE ASSIGNED SYSTEM-WIDE ORGANIZATIONAL OR EXECUTIVE TEAM GOALS AS WELL AS INDIVIDUAL GOALS AS DEVELOPED BY THE PRESIDENT AND CEO AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE SYSTEM-WIDE GOALS WILL BE CONSISTENT FOR ALL PARTICIPANTS. THESE GOALS WILL BE A QUANTITATIVE MEASURE OF BROAD SYSTEM PERFORMANCE SUCH AS METRICS AS DEFINED ABOVE. INDIVIDUAL GOALS AND OBJECTIVES AND THEIR RELATIVE WEIGHTING FOR THE 3RD AND 4TH QUARTER ARE CONTAINED IN THE EXECUTIVE POSITION INCENTIVE PLAN GOALS AND OBJECTIVES DOCUMENT WHICH IS ATTACHED TO THIS DOCUMENT. WEIGHTING OF PLAN METRICS: PLAN GOALS WILL BE WEIGHTED FOR PURPOSES OF CALCULATING INDIVIDUAL INCENTIVE AWARDS. THE FOLLOWING SCHEDULE SHALL BE USED IN THAT PROCESS: PRESIDENT AND CEO SYSTEM-WIDE (TEAM) 70% INDIVIDUAL 20% DISCRETIONARY 10% ALL OTHER POSITIONS SYSTEM-WIDE (TEAM) 60% INDIVIDUAL 30% DISCRETIONARY 10% EXECUTIVE OBJECTIVES: OBJECTIVES MAY VARY IN WEIGHTING AS DETERMINED BY ORGANIZATIONAL AND DEPARTMENTAL PRIORITIES. AMENDMENT/TERMINATION OF THE PLAN: UPON APPROVAL BY THE BOARD OF DIRECTORS, THE PLAN MAY BE AMENDED, REVISED AND/OR TERMINATED, WITH OR WITHOUT NOTICE, AT ANY GIVEN TIME. PLAN ADMINISTRATION: THE SPECIFICS OF PLAN ADMINISTRATION ARE DEFINED IN THE "MASTER EXECUTIVE INCENTIVE COMPENSATION PLAN" DOCUMENT.
PUBLIC DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 CHARTERCARE HEALTH PARTNERS AND AFFILIATES MAKE THEIR TAX RETURNS, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THEIR TAX RETURNS ARE ALSO AVAILABLE ON WWW.GUIDESTAR.ORG.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KENNETH H BELCHER TITLE:PRESIDENT AND CEO HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL CONKLIN JR TITLE:CFO/TREASURER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIMBERLY O'CONNELL TITLE:VP LEGAL/SECRETARY HOURS:4
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHARTERCARE HEALTH PARTNERS
 
Employer identification number

26-4235815
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) SJ ENERGY LLC
200 HIGH SERVICE AVENUE
NORTH PROVIDENCE,RI02904
20-8591473 		PROCUREMENT RI 0 0 CCHP
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CHARTERCARE HEALTH PARTNERS FOUNDATION

200 HIGH SERVICE AVENUE

NORTH PROVIDENCE,RI02904
26-0236669 		FUNDRAISING RI 501 (C) 3 7 CCHP
 
 
 
(2) ROGER WILLIAMS REALTY CORPORATION

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0423855 		RENTAL MGMT RI 501 (C) 3 11A CCHP
 
 
 
(3) RWGH PHYSICIANS OFFICE BUILDING

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0398588 		RENTAL MGMT RI 501 (C) 3 11A CCHP
 
 
 
(4) ELMHURST EXTENDED CARE FACILITIES

50 MAUDE STREET

PROVIDENCE,RI02908
22-2723407 		NURSING HOME RI 501 (C) 3 3 CCHP
 
 
 
(5) ROGER WILLIAMS MEDICAL ASSOCIATES

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
20-3346936 		PHY. PRACTICE RI 501 (C) 3 11A CCHP
 
 
 
(6) ST JOSEPH HEALTH SERVICES OF RI

200 HIGH SERVICE AVENUE

NORTH PROVIDENCE,RI02904
05-0259026 		HEALTHCARE RI 501 (C) 3 3 CCHP
 
 
 
(7) ROGER WILLIAMS MEDICAL CENTER

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0258959 		HEALTHCARE RI 501 (C) 3 3 CCHP
 
 
 
(8) ST JOSEPH HOSPITAL WORKERS COMP TRUST

200 HIGH SERVICE AVENUE

NORTH PROVIDENCE,RI02904
05-6106574 		TRUST RI 501 (C) 3 11D SJHSRI
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) SOUTHERN NEW ENGLAND REHABILITATION

200 HIGH SERVICE AVE
NORTH PROVIDENCE,RI02904
05-0482868 		MANAGEMENT RI SJHSRI
  		RELATED 0 0   No 0   No 50.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) ELMHURST HEALTH ASSOCIATES
825 CHALKSTONE AVENUE
PROVIDENCE,RI02908
05-0437610 		LABORATORY RI NA
  		C Corp -4,500 501,650 100.000 %
(2) ROSEBANK CORPORATION
825 CHALKSTONE AVENUE
PROVIDENCE,RI02908
05-0342046 		REAL ESTATE RI NA
  		C Corp -41,828 332,822 100.000 %
(3) OUR LADY OF FATIMA ANCILLARY SERVICES
200 HIGH SERVICE AVENUE
NORTH PROVIDENCE,RI02904
05-0519862 		LABORATORY RI NA
  		C Corp -128,550 770,374 100.000 %








Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ROGER WILLIAMS MEDICAL CENTER

 k 7,160,169  
(2) ST JOSEPH HEALTH SERVICES OF RI

 k 7,160,169  
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
TRANSACTIONS WITH RELATED ORGANIZATIONS PART V ROGER WILLIAMS MEDICAL CENTER AND ST JOSEPH HEALTH SERVICES OF RI PAY CHARTERCARE MANAGEMENT FEES TO PERFORM SERVICES ON THEIR BEHALF, SHARE FACILITIES AND EMPLOYEES, AND TO REIMBURSE FOR EXPENSES.
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