Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
St Joseph Medical Group
Employer identification number
20-8544021
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
1,188,573
1,147,540
4,776,136
4,915,865
5,681,107
17,709,221
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......
369,702
3,151,458
4,674,830
5,438,055
6,981,544
20,615,589
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.
1,558,275
4,298,998
9,450,966
10,353,920
12,662,651
38,324,810
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.)
38,324,810
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...
1,558,275
4,298,998
9,450,966
10,353,920
12,662,651
38,324,810
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
72
536
138
132
151
1,029
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
72
536
138
132
151
1,029
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.)
110
110
13
Total support (Add lines 9, 10c, 11 and 12.).
1,558,347
4,299,534
9,451,104
10,354,162
12,662,802
38,325,949
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
St Joseph Medical Group
Employer identification number
20-8544021
Identifier
Return Reference
Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENT
FORM 990, PART III, Q. 4A
ST. JOSEPH MEDICAL GROUP (SJMG) PROVIDES QUALITY PROFESSIONAL MEDICAL SERVICES TO ITS COMMUNITY IN CONJUNCTION WITH, AND IN SUPPORT OF, ST. JOSEPH REGIONAL HEALTH NETWORK, IN READING, PENNSYLVANIA, WHICH IS ALSO A 501(C)(3) CHARITABLE, TAX EXEMPT ORGANIZATION. SJMG PROVIDES THESE SERVICES TO THE CITIZENS OF ITS COMMUNITY WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP OR AGE. IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES AND MEDICAL EDUCATION. THEREFORE, IN KEEPING WITH THE COMMITMENT OF SJMG AND ST. JOSEPH HEALTH NETWORK TO SERVE ALL MEMBERS OF THE COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENT PROGRAMS AT BELOW COST, AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND INDIVIDUAL'S INABILITY TO PAY COEXSIST. SJMG PROVIDES THE FOLLOWING PROFESSIONAL MEDICAL SERVICES TO ITS COMMUNITY THROUGH ITS DULY-LICENSED PHYSICIANS, EMPLOYEES AND CONTRACTORS: FAMILY MEDICINE, OB/GYN, GENERAL SURGICAL SERVICES, NEUROLOGY, NEUROSURGERY AND CONTINUING COMMUNITY AND MEDICAL EDUCATION SERVICES.
Organization's Corporate Members/ Stockholders
FORM 990, PART VI, Q. 6
ACCORDING TO THE BYLAWS OF ST. JOSEPH MEDICAL GROUP, THE ENTITY'S SOLE MEMBER IS BORNEMANN HEALTH CORPORATION, A PENNSYLVANIA NONPROFIT CORPORATION.
Members/Stockholders Electing Governing Body
FORM 990, PART VI, Q. 7A
THE SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
Approval of Governing Body Decisions by Members/Stockholders
FORM 990, PART VI, Q. 7B
St.Joseph Medical Group's (SJMG) corporate member is Borneman Health Corporation (BHC). Pursuant to Section 5.4 of SJMG's bylaws the corporate member has the right to approve or disapprove any of the following actions: - Any change in the mission or philosophy of the corporation; - any amendment to the articles of incorporation or the bylaws of the corporation; - the removal, with or without cause, of any member of the board of directors of the corporation; - the incurrence of debt, including without limitation, borrowings, guarantees, loans, encumbrances, operating leases, and capital leases, in excess of thresholds and within the limits established from time to time by the corporate member; - any joint venture to which the corporation is a party; - the creation of a new corporation, partnership or limited liability company of the corporation; - any merger, consolidation, reorganization, dissolution or liquidation of the corporation; - Sale, lease or other disposition of any real or personal property of the corporation with a value in excess of certain dollar limits to be set from time to time by the corporate member, but only where such sale, lease or other disposition has not otherwise been previously approved by the corporate member in the corporation's budgeting process or otherwise; - sale, release, dissolution, transfer, exchange or other disposition of any organization (or of all or substantially all of the assets of such organization) controlled by the corporation; - the adoption of long range and strategic plans; - the adoption of operating and capital budgets and amdendments therto; and - any variations from previously approved operating and/or capital budgets, in excess of thresholds established by the corporate member; - expenditures for (i) non-budgeted items in excess of certain dollar limits set from time to time by the member, and (ii) items which are included in the corporation's annual budgets but which exceed the budgeted amount by an amount in excess of certain dollar limits set from time to time by the corporate member. In addition to the rights reserved to the corporate member, the corporate member shall have the power to transfer assets of the corporation or to require the corporation to transfer assets to the corporate member to the extent necessary to accomplish the corporate member's goals and objectives, and to provide for the payment of all indebtedness of the corporate member or an entity controlled by, controlling, or under common control with the corporate member, issued or incurred by or on behalf of the corporate member or a corporate member affiliate in furtherance of the corporate member's goal and objectives.
Process the Organization uses to review form 990
FORM 990, PART VI, Q. 11b
Once the return is prepared, the return is reviewed by the Director of Finance and Chief Financial Officer. The Chief Financial Officer provides a copy of the return to the St. Joseph Medical Group's board either at a board meeting or electronically. Subsequent to providing a copy to the board, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
Procedures for Monitoring and Enforcing the COI Policy
FORM 990, PART VI, Q. 12c
The Board of Directors and Organization leaders annually disclose any potential or actual conflicts of interest. The Compliance Officer reviews each of the disclosure statements and prepares a report detailing any identified conflicts. The conflict disclosure review is presented at the Board Affairs Committee. All employees and Board members receive education on conflicts of interest, with Board meetings and physician transaction review meetings starting with a request to declare potential conflicts with agenda items. Any potential issues are reviewed and individuals with a material conflict are permitted to participate in discussions but do not participate in the vote on any action item. Department leaders disclose any potential employee conflicts to the CRO with the CEO determining the course of action for any potentially significant conflicts.
Process for Determining CEO's Compensation
FORM 990, PART VI, Q. 15A
The organization's CEO's compensation is paid by CHI. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September, 2011. In addition, in December 2009, hay group completed a comprehensive review of all positions at the level of vice president and above to determine and validate appropriate compensation levels.
Process for Determining Compensation - Officers/Key Employees
FORM 990, PART VI, Q. 15B
DURING THE TAX YEAR ENDED JUNE 30, 2011, NO OFFICERS, DIRECTORS, OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION WAS PAID BY ST. JOSEPH REGIONAL HEALTH NETWORK, A RELATED ORGANIZATION, AND WAS SET BY A COMPENSATION COMMITTEE WHO UTILIZED AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THE ST. JOSEPH REGIONAL HEALTH NETWORK BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS TO ENSURE REASONABLENESS OR COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY.
Public Inspection of Documents
FORM 990, PART VI, Q. 19
The Organization's conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.CatholicHealthInit.org or at www.DACBOND.org.
Estimate of Hours
Form 990, Part VII
COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR PER WEEK EMPLOYEES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.