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
Reliant Medical Group Inc
Employer identification number
04-2472266
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.") .
0
0
34,900
39,277
75,526
149,703
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......
263,720,367
275,265,261
284,102,388
284,261,377
298,666,539
1,406,015,932
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.
263,720,367
275,265,261
284,137,288
284,300,654
298,742,065
1,406,165,635
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
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
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public Support (Subtract line 7c from line 6.)
1,406,165,635
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...
263,720,367
275,265,261
284,137,288
284,300,654
298,742,065
1,406,165,635
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
3,052,061
1,605,581
1,981,744
1,075,103
1,296,656
9,011,145
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
3,052,061
1,605,581
1,981,744
1,075,103
1,296,656
9,011,145
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
7,417
-2,917
0
0
7,423
11,923
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.).
266,779,845
276,867,925
286,119,032
285,375,757
300,046,144
1,415,188,703
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
99.362 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
0 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.637 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Reliant Medical Group Inc
Employer identification number
04-2472266
Identifier
Return Reference
Explanation
Form 990, Supplemental Information
Part VI, lines 1A, 1B and 4 Lines 1a & 1b - Bylaws state that physician trustee terms will not exceed 9 consecutive years. Although the Board elected a current trustee as Board Chair in FY11, a re-election to his current Trustee seat would have resulted in him serving in excess of the 9 year term limit. The Board voted to keep the trustee on in Board Chair capacity as a voting member, and another employed physician was elected to the trustee position he vacated. This created an equal number of physician trustees and community trustees. PART VI, LINE 2 MICHAEL DIPIERRO, BRUCE PLUMMER, Michael Kelleher MD, and Randi Nichols HAD A BUSINESS RELATIONSHIP since they served jointly on the Boards of Central Massachusetts Indemnity Company and Massachusetts Assurance Company. JOHN SCHNEEWEIS MD, Robert Yood MD, KAREN CANAS, AND JACK DUTZAR MD HAD A BUSINESS RELATIONSHIP since they served jointly on the Board of Aspectus, Inc. Line 4 - On October 1, 2011 Reliant Medical Group became affiliated with Atrius Health, with Atrius becoming the sole corporate member of Reliant Medical Group. As such, Amended Articles of Organization were filed with the Commonwealth of Massachusetts and new Bylaws were approved. Reliant Medical Group changed its name from Fallon Clinic, Inc. in association with this event. Part VI, Question 6 Employed MDs, ODS and DPMs are eligible to become voting members of the organization. They must be employed for 2 full years and meet specific eligibility criteria prior to being approved by medical leadership. Potential members are then placed on a ballot and must receive a majority vote of the members in attendance at a meeting called for such purpose. Atrius Health became the sole corporate member of Reliant Medical Group On October 1, 2011. Form 990, Part VI, Question 7a Per Bylaws, current voting members of the organization nominate other voting members for election to open Board seats each year. Nominees may accept or decline the nomination; those who accept are placed on a written ballot and elected by a majority vote of members at each Annual Meeting of the organization. Atrius Health became the sole corporate member of Reliant Medical Group On October 1, 2011. The corporate member has the authority to approve, or disapprove, the selection or removal of at least 50% but less than 80% of Reliant Trustees on an annual basis. Form 990, Part VI, Question 7b Any recommended changes to the organization's Articles or Bylaws must be approved by a majority vote of existing voting members, in addition to any merger or consolidation with another entity. Effective 10/1/2011, the sole corporate member (Atrius Health) must approve certain actions of Reliant's Board, which include amending Articles or Bylaws, adoption of budgets, sale or disposition of material assets, mergers, consolidations or affiliations affecting governance, liquidation, dissolution or restructuring, adoption of compensation structure and ranges for employed trustees, physician members and administrative observers. They must also approve or disapprove the selection or removal of at least fifty percent but less than eighty percent of Reliant Trustees on an annual basis. Form 990, Part VI, Question 11B Reliant Medical Group has engaged Ernst and Young, LLP to assist in the preparation and review of its 2010 990 tax form. An internal staff comprised of Reliant Medical Group's Controller, Corporate Paralegal, Chairperson of Compensation Committee, and Accounting staff work in concert with Ernst and Young, LLP to complete its tax form. The Audit and Compliance Committee has been delegated the responsibility by the Board of Trustees to oversee the preparation and review of the Form 990. Upon completion of a draft Form 990, the Controller reviews the form in its entirety with the Committee, presenting major highlights and issues, if any, and then a formal approval of the 990 form is made. A final draft of Form 990 is subsequently provided in either hard copy or electronic form to the Board of Trustees prior to submission to the IRS. Form 990, Part VI, Question 12c MONITORING ANNUALLY, EACH TRUSTEE COMPLETES AND SUBMITS A CONFLICT OF INTEREST DISCLOSURE STATEMENT (COI). STATEMENTS ARE REVIEWED AS FOLLOWS: THE CEO'S COI IS REVIEWED BY THE CHAIRMAN OF THE BOARD WITH A COPY TO EXTERNAL CORPORATE COUNSEL; THE CHAIRMAN'S COI IS REVIEWED BY THE CEO WITH A COPY TO EXTERNAL CORPORATE COUNSEL; INDEPENDENT TRUSTEE'S COI'S ARE REVIEWED BY THE CHAIRMAN OR THE CEO WITH COPIES TO EXTERNAL CORPORATE COUNSEL; PHYSICIAN TRUSTEES AND SENIOR STAFF'S COI'S ARE REVIEWED BY THE CHAIRMAN OF THE AUDIT/COMPLIANCE COMMITTEE OR THE CEO WITH COPIES OF POTENTIAL CONFLICTS COMMUNICATED TO THE CEO AND EXTERNAL CORPORATE COUNSEL. AFTER REVIEW, THE COIS ARE FILED AND MAINTAINED BY THE ASSISTANT CLERK. ENFORCEMENT IF AN INTERESTED INDIVIDUAL PRESENTS AN ITEM AT A BOARD MEETING, HE/SHE IS REQUIRED TO LEAVE THE MEETING DURING DISCUSSION AND VOTING ON ANY TRANSACTION WHICH MAY RESULT IN A CONFLICT. ANY DISCLOSURE OF A FINANCIAL INTEREST OR CONFLICT OF INTEREST MUST BE DETAILED IN THE MEETING MINUTES. WHO IS COVERED? THE ORGANIZATION'S CONFLICT OF INTEREST DISCLOSURE STATEMENT COVERS EACH MEMBER OF THE ORGANIZATION'S BOARD OF TRUSTEES, THE CEO AND SENIOR MANAGEMENT. Form 990, Part VI, Questions 15a and 15b The process established by the Board of Trustees allows for the compensation committee to handle the review and approval of the compensation package for the CEO, the executive management team, all physicians who will potentially earn more than 95% of the AMGA level of pay, stipends for members of the Board of Trustees, and any other matters so designated to come before the committee. The committee meets quarterly and as needed to handle any matter that requires attention in a timely manner. The committee uses the services of an independent, outside consulting firm to provide background information as well as local and regional comparison data on the areas of oversight of the committee. The consultant is available at all times to consider matters which require his input for the committee's questions. The committee conducts its deliberations and reports to the full board at each meeting. The process was last completed in September, 2011. Form 990, Part VI, Question 19 The organization's financial statements, conflict of interest policy and governing documents are available upon request. Form 990, Part VII Board members receive annual stipends of $6,000 for their active role as a trustee. They also receive $1,000 per Board meeting attended and $500 per Board appointed committee meeting attendance. Officers receive an additional $5,000 for their role as an officer. All other compensation disclosed is earned while performing normal job functions. HOURS DEVOTED TO RELATED ORGANIZATIONS THE FOLLOWING INDIVIDUALS DEVOTE TIME TO RELATED ORGANIZATION LAKEVIEW MEDICAL, INC. MICHAEL DIPIERRO - 1 HOUR KEVIN O'SULLIVAN - 1 HOUR JOHN SCHNEEWEIS - 1 HOUR KAREN CANAS - 1 HOUR BRUCE PLUMMER - 1 HOUR JACK DUTZAR - 1 HOUR THE FOLLOWING INDIVIDUALS DEVOTE TIME TO RELATED ORGANIZATION RELIANT MEDICAL GROUP FOUNDATION, INC: MICHAEL DIPIERRO - 4 HOURS LEON JOSEPHS - 1 HOUR ROBERT KOSSACK - 1 HOUR JOHN SCHNEEWEIS - 1 HOUR KAREN CANAS - 1 HOUR JACK DUTZAR - 1 HOUR MICHAEL SHEEHY - 1 HOUR WILLIAM BALCOM - 1 HOUR MARK STOKER - 1 HOUR IVAN GREEN - 1 HOUR ACHAL AGGARWAL - 1 HOUR PAUL ARCAND - 1 HOUR Form 990, Part XI, Line 5 Other changes in net assets includes: Change in Pension Funding Obligation ($6,148,812) Net change in value of swap agreements $107,065 Change in net unrealized gain on investments $100,479 Partnership UBI ($7,423) Total ($5,948,691) ============
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.