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
SOUTHCOAST PHYSICIANS SERVICES INC
Employer identification number
22-2703314
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.") .
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......
9,605,145
18,816,377
29,747,098
41,375,896
54,978,750
154,523,266
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.
9,605,145
18,816,377
29,747,098
41,375,896
54,978,750
154,523,266
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
154,523,266
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...
9,605,145
18,816,377
29,747,098
41,375,896
54,978,750
154,523,266
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
21,486
30,905
807
8,077
19,782
81,057
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
21,486
30,905
807
8,077
19,782
81,057
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.).
9,626,631
18,847,282
29,747,905
41,383,973
54,998,532
154,604,323
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
99.950 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.900 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.050 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.100 %
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
SOUTHCOAST PHYSICIANS SERVICES INC
Employer identification number
22-2703314
Identifier
Return Reference
Explanation
FORM 990, PART I LINE 1
THE MISSION OF SOUTHCOAST PHYSICIAN SERVICES, INC. ("SPS")IS TO CARE FOR AND IMPROVE THE HEALTH, AND TO PROMOTE THE WELLNESS, OF THE INDIVIDUALS AND COMMUNITIES WE SERVE.
FORM 990, PART III, LINE 4A
SPS'S ACCOMPLISHMENTS INCLUDE THE DEVELOPMENT AND MAINTENANCE OF AN EFFICIENT AND INTEGRATED PRIMARY CARE DELIVERY SYSTEM THAT SUCCESSFULLY MEETS THE HEALTH CARE NEEDS OF THE COMMUNITIES SERVED BY SPS AND ITS NON-PROFIT AFFILIATES. SPS SERVES PATIENTS OF ALL AGES, RACES AND ETHNIC BACKGROUNDS AND PROVIDES HEALTH CARE SERVICES SUCH AS PREVENTATIVE HEALTH CARE, PHYSICALS, IMMUNIZATIONS, TREATMENTS FOR ILLNESSES AND INJURIES AND PROVIDES REFERRALS TO OTHER HEALTH CARE SPECIALISTS AS NEEDED. DURING FISCAL 2011, APPROXIMATELY 34.2% OF PATIENT VISITS TO SPS PRIMARY CARE PRACTICES WERE ATTRIBUTABLE TO PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MEDICARE AND ANOTHER 5.0% OF VISITS WERE PROVIDED TO PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MASSHEALTH (MEDICAID) AND COMMONWEALTH CARE PLANS. DURING FISCAL 2011, THERE WERE 153,703 TOTAL PATIENT VISITS TO SPS PRIMARY CARE PRACTICES AND 16,593 IMMUNIZATIONS WERE ADMINISTERED TO SPS PATIENTS.
FORM 990, PART III, LINE 4B
SPS EMPLOYS HOSPITALISTS WHO ARE PHYSICIANS BOARD CERTIFIED IN INTERNAL MEDICINE OR FAMILY PRACTICE AND SPECIALIZE IN THE CARE OF PATIENTS WHOSE ILLNESS IS SERIOUS ENOUGH TO REQUIRE ADMISSION TO AN ACUTE-CARE HOSPITAL. SOMETIMES HOSPITALISTS HAVE ADDITIONAL EXPERTISE IN SPECIALTIES SUCH AS PULMONARY MEDICINE OR CRITICAL CARE. THE HOSPITALISTS PRIMARY FOCUS OF CARE AND EXPERTISE IS FOR THE PATIENTS OF ITS RELATED NOT-FOR-PROFIT HOSPITAL THEY SERVE, SOUTHCOAST HOSPITALS GROUP, INC. HOSPITALISTS ARE AVAILABLE TO SEE ADMITTED PATIENTS 24 HOURS A DAY 7 DAYS A WEEK AND PROVIDE COMPLETE CARE TO PATIENTS DURING THEIR HOSPITAL STAY WHILE COMMUNICATING WITH NURSES, OTHER HEALTH TEAM MEMBERS AND EACH PATIENT'S PRIMARY CARE PHYSICIANS THEREBY PROVIDING THE HIGHEST LEVEL OF HEALTH CARE SERVICES. DURING FISCAL 2011 THE HOSPITALISTS MADE 99,571 PATIENT VISITS, OF WHICH 58.1% OF ALL VISITS WERE MADE TO PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MEDICARE AND ANOTHER 13.8% OF VISITS WERE PROVIDED TO PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MASSHEALTH (MEDICAID) AND COMMONWEALTH CARE PLANS.
FORM 990, PART III, LINE 4C
SPS EMPLOYS SURGEONS, SOME OF WHOM PERFORM GENERAL SURGERIES, AND OTHERS WHO PERFORM SURGERIES IN SPECIALTIES SUCH AS NEUROSURGERY AND BARIATRIC SURGERY.DURING FISCAL 2011, SPS SURGEONS SERVED 38,828 PATIENTS, OF WHICH 28.5% WERE PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MEDICARE AND ANOTHER 8.7% WERE PATIENTS WHOSE PRIMARY HEALTH INSURANCE WAS MASSHEALTH (MEDICAID) AND COMMONWEALTH CARE PLANS.
FORM 990, PART VI, SECTION A, LINE 6
SOUTHCOAST HEALTH SYSTEM, INC., SPS'S PARENT CORPORATION, IS THE SOLE CORPORATE MEMBER OF SOUTHCOAST PHYSICIAN SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
SOUTHCOAST HEALTH SYSTEM, INC. ELECTS THE TRUSTEES AND DIRECTORS OF SOUTHCOAST PHYSICIAN SERVICES, INC. AND EXERCISES SPECIFIED RESERVED POWERS OVER SOUTHCOAST PHYSICIAN SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7B
SOUTHCOAST PHYSICIAN SERVICES, INC. IS ORGANIZED AND OPERATES TO CARRY OUT AND FURTHER THE TAX EXEMPT PURPOSES OF ITS NON-PROFIT AFFILIATE, SOUTHCOAST HOSPITALS GROUP, INC., BY CARING FOR AND IMPROVING THE HEALTH AND PROMOTING THE WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY THE HOSPITALS GROUP
FORM 990, PART VI, SECTION B, LINE 11
THE GOVERNING BOARD OF SOUTHCOAST HEALTH SYSTEM, INC. (SHS), THE SOLE CORPORATE MEMBER OF SPS, REVIEWS FORM 990 AND ITS SCHEDULES PRIOR TO FILING. THE REVIEW IS PERFORMED BY THIS GOVERNING BOARD AS IT PROVIDES DIRECT OVERSIGHT FOR COMPENSATION AND CONFLICT OF INTEREST MATTERS FOR SPS AND ITS AFFILIATES ON A SYSTEM-WIDE BASIS. FORM 990 AND ITS SCHEDULES ARE PRESENTED TO THE SHS BOARD DURING A REGULARLY SCHEDULED BOARD MEETING AND TRUSTEES ARE PROVIDED WITH A COMPLETE COPY WITH SUFFICIENT TIME TO REVIEW, MAKE INQUIRIES AND HAVE ANY ADJUSTMENTS MADE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
SHS HAS CONFLICT OF INTEREST, LEGAL COMPLIANCE AND CODE OF CONDUCT POLICIES THAT APPLY TO ALL TRUSTEES, OFFICERS, EMPLOYEES, AND VOLUNTEERS (REFERRED TO AS "MEMBERS"). THE PRESIDENT OF SPS'S PARENT, SOUTHCOAST HEALTH SYSTEM, INC. (SHS), IS RESPONSIBLE FOR INFORMING ALL MEMBERS OF THIS POLICY. THE CHAIRMAN OF SHS'S BOARD IS RESPONSIBLE FOR MAKING AN INITIAL DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS WITH RESPECT TO ANY TRUSTEE OR DIRECTOR OF SPS OR ANY OF ITS AFFILIATES. THE PRESIDENT OF SHS IS RESPONSIBLE FOR MAKING AN INITIAL DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS AS TO ANY MEMBER OTHER THAN A TRUSTEE OR DIRECTOR. IN THE EVENT OF A POTENTIAL CONFLICT RELATING TO THE CHAIRMAN OF SHS, THE MATTER WOULD BE REPORTED TO THE PRESIDENT OF SHS AND REFERRED AUTOMATICALLY TO SHS'S GOVERNANCE COMMITTEE FOR DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. IN THE EVENT THE AFFECTED MEMBER DISAGREES WITH THE INITIAL DETERMINATION OF THE CHAIRMAN OR PRESIDENT, AS APPLICABLE, THEN UPON REQUEST, HE OR SHE MAY BE AFFORDED THE OPPORTUNITY TO DISCUSS THE ISSUE WITH THE SHS GOVERNANCE COMMITTEE, WHICH HAS THE FINAL AUTHORITY IN ITS SOLE DISCRETION TO DETERMINE WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. THE AFFECTED MEMBER, IF A MEMBER OF THE GOVERNANCE COMMITTEE, MUST REMOVE HIMSELF FROM THE ROOM DURING ANY DISCUSSION OF THE MATTER (AFTER HIS INITIAL PRESENTATION) AND REFRAIN FROM PARTICIPATING IN ANY VOTE OR OTHER DECISION MAKING IN REGARD TO THE MATTER. THE MINUTES OF THE MEETING WOULD REFLECT THAT A FULL AND ACCURATE DISCLOSURE WAS MADE, THAT THE MEMBER ABSTAINED FROM VOTING OR DECISION MAKING, AND THAT A QUORUM WAS OTHERWISE PRESENT. VIOLATION OF THIS POLICY MAY RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM OFFICE. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD. THE BOARD IS ADVISED OF THE POLICY PRIOR TO SELECTION AS A MEMBER, AND IS REQUIRED TO FILE WITHIN 30 DAYS THEREAFTER THE CONFLICT OF INTEREST DISCLOSURE STATEMENT.
FORM 990, PART VI, SECTION B, LINE 15
FOR ITS PHYSICIAN EMPLOYEES, COMPENSATION IS REVIEWED AND APPROVED UPON EMPLOYMENT OR ADJUSTMENT OR AT LEAST ANNUALLY BY A COMMITTEE OF THE BOARD COMPRISED OF ALL NON-PHYSICIAN TRUSTEES. AS PART OF THE REVIEW, AN INDEPENDENT PHYSICIAN COMPENSATION CONSULTANT IS ENGAGED TO EXPRESS A FAIR MARKET VALUE OPINION ON OFFERS OR EMPLOYMENT OR FOR SALARY ADJUSTMENTS FOR ALL EXPERIENCED PHYSICIANS AND ASSIST IN THE DEVELOPMENT OF SALARY RANGES FOR PHYSICIANS BEING EMPLOYED WHO HAVE RECENTLY GRADUATED FROM TRAINING PROGRAMS. THE CONSULTANT USES SAFE-HARBOR GUIDELINES SET BY THE FEDERAL LEGISLATION OR DEVELOPED BY FEDERAL AGENCIES IN FORMULATING THE OPINIONS AND DEVELOPING THE SALARY RANGES.
FORM 990, PART VI, SECTION C, LINE 19
SPS MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY PROVIDING THEM UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
EQUITY TRANSFERS FROM SPS'S PARENT CORPORATION SHS 6,677,230. TOTAL TO FORM 990, PART XI, LINE 5: 6,677,230.
FORM 990, PART XI, LINE 5:
OTHER CHANGES IN NET ASSETS INCLUDE EQUITY TRANSFERS FROM SPS'S PARENT CORPORATION, SOUTHCOAST HEALTH SYSTEM, INC., WHICH TOTALLED $6,677,230 FOR FISCAL 2011.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.