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
2011
Open to Public Inspection
Name of the organization
BOCA RATON REGIONAL HOSPITAL INC
Employer identification number
59-1006663
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
BOCA RATON REGIONAL HOSPITAL INC
Employer identification number
59-1006663
Identifier
Return Reference
Explanation
DESCRIPTION OF RELATIONSHIPS
FORM 990, PART VI, QUESTION 2 JERRY FEDELE, DAWN JAVERSACK AND ALEX EREMIA HAVE A BUSINESS RELATIONSHIP, IN THAT, IN THEIR MANAGEMENT CAPACITY FOR BRRH CORPORATION AND AFFILIATES, THEY ALSO SERVE ON THE BOARDS AND/OR ARE OFFICER(S) OF THE FOLLOWING FOR-PROFIT CORPORATIONS WHICH ARE WHOLLY OWNED BY BOCA RATON REGIONAL HOSPITAL, INC.: BOCACARE, INC. BOCACARE EAST, INC. BOCACARE 9TH AVE., INC. BRRH WOMEN'S INSTITUTE FOR HEALTH & WELLNESS, INC. MATTHEW KLEIN AND ANDREW ROSS HAVE A BUSINESS RELATIONSHIP, IN THAT THEY ARE CO-OWNERS IN A FOR-PROFIT PHYSICIAN PRACTICE. DOES ORGANIZATION HAVE MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 THE SOLE MEMBER OF BOCA RATON REGIONAL HOSPITAL, INC., IS BRRH CORPORATION, INC. ELECTION OF MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, QUESTION 7A THE SOLE CORPORATE MEMBER, BRRH CORPORATION, MAY ELECT, REMOVE WITH OR WITHOUT CAUSE, REPLACE AND FILL ANY VACANCY ON THE BOARD OF TRUSTEES OF THE HOSPITAL. CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER, BRRH CORPORATION INCLUDE: - APPROVE IN ADVANCE: CANDIDATES ARE PROPOSED BY THE CORPORATION TO BE ELECTED BY THE CORPORATION'S BOARD AS OFFICERS OF THE CORPORATION AND APPROVE IN ADVANCE THE REMOVAL, TERMINATION AND REPLACEMENT OF SUCH OFFICERS BY THE CORPORATION'S BOARD; - APPROVE IN ADVANCE: CANDIDATES PROPOSED BY THE CORPORATION TO BE ELECTED BY THE CORPORATION TO SERVE AS TRUSTEES OR DIRECTORS ON THE BOARDS OF THOSE AFFILIATED ORGANIZATIONS OF WHICH THE CORPORATION IS THE SOLE MEMBER OR SHAREHOLDER, INCLUDING BRRH HOME HEALTH SERVICE, INC., BOCA RATON REGIONAL HOSPITAL SELF INSURANCE TRUST AND BRRH HEALTH PLANS, INC.; - AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION; - AMEND, ALTER, RESTATE, RESCIND OR REPEAL THESE BYLAWS; PROVIDED, HOWEVER, THAT THESE BYLAWS AND ANY AMENDMENTS HERETO SHALL NOT BE INCONSISTENT WITH PROVISION OF THE ARTICLES OF INCORPORATION; - APPROVE IN ADVANCE OF ADOPTION BY THE CORPORATION ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET OF THE CORPORATION OR ANY CHANGE THEREIN EXCEEDING ONE PERCENT (1%) IN THE AGGREGATE OF THE TOTAL ORIGINAL APPROVED BUDGET; - APPROVE IN ADVANCE OF THE CORPORATION'S AUTHORIZATION ANY CONTRACTS OR ANY TRANSACTIONS OF THE CORPORATION WHICH ARE NOT PROVIDED FOR IN THE ANNUAL OR LONG TERM CAPITAL OR OPERATIONAL BUDGET APPROVED BY THE MEMBER WHERE THE AMOUNT INVOLVED EXCEEDS ONE HUNDRED THOUSAND DOLLARS ($100,000) IN THE AGGREGATE; - CAUSE THE CORPORATION TO ENTER INTO SUCH CONTRACTS FROM TIME TO TIME AS THE MEMBER MAY DETERMINE AND DIRECT, AND TO PLEDGE, HYPOTHECATE, MORTGAGE, TRANSFER OR OTHERWISE ENCUMBER ALL OR ANY PORTION OF THE ASSETS OF THE CORPORATION FROM TIME TO TIME, IN EACH CASE AS DETERMINED BY THE MEMBER IN ITS DISCRETION AND WITHOUT THE NECESSITY OF ANY FORMAL CORPORATE ACTION BY THE CORPORATION; - ADOPT ANY NEW, OR ANY CHANGES TO EXISTING, LONG-TERM OR MASTER INSTITUTIONAL PLANS OF THE HOSPITAL AFTER CONSIDERING ANY RECOMMENDATIONS OF THE CORPORATION; -ADOPT A PLAN OF DISSOLUTION OF THE CORPORATION; - AUTHORIZE THE CORPORATION TO ENGAGE IN, OR ENTER INTO, ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL; - ADOPT A PLAN OF MERGER OR CONSOLIDATION OF THE CORPORATION WITH ANOTHER CORPORATION; - APPROVE ANY CONTRIBUTION, GRANTS, OR LOANS PROPOSED TO BE MADE BY THE CORPORATION TO ANY OTHER ORGANIZATION OR CORPORATION OTHER THAN THE MEMBER; OR - CAUSE OR PERMIT THE CORPORATION'S ORGANIZATION OR ACQUISITION OF OR INVESTMENT IN, ANY ENTITY, INCLUDING ANY CORPORATION, LIMITED LIABILITY COMPANY, ASSOCIATION, PARTNERSHIP, TRUST, JOINT VENTURE OR OTHER ENTITY. DESCRIBE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED WITH THE FINANCE COMMITTEE, A SUBCOMMITTEE COMPRISED OF MEMBERS OF THE BRRH CORPORATION'S BOARD OF TRUSTEES, PRIOR TO FILING. THE 990 IS PRESENTED TO BRRH CORPORATION'S BOARD OF TRUSTEES AFTER FILING. ANY QUESTIONS AND CONCERNS OF THE MEMBERS OF THE FINANCE COMMITTEE ARE ADDRESSED PRIOR TO THE SUBMISSION OF THE FORM 990 TO THE INTERNAL REVENUE SERVICE. NOT ALL MEMBERS OF THE FINANCE COMMITTEE OR BOARD OF TRUSTEES ARE PRESENT AT THE RESPECTIVE MEETINGS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C THE CHAIR OF THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD AND THE CHIEF COMPLIANCE OFFICER REVIEW THE CONFLICT OF INTEREST STATEMENTS. IT IS DOCUMENTED IN THE BOARD MEETING MINUTES THAT MEMBERS WITH POTENTIAL CONFLICTS RECUSE THEMSELVES FROM INVOLVEMENT IN DISCUSSIONS/BOARD ACTIONS RELATING TO THE POTENTIAL CONFLICTS. MANAGEMENT POTENTIAL CONFLICTS WOULD BE DISCLOSED TO AUDIT & COMPLIANCE COMMITTEE. WRITTEN POLICIES FORM 990, PART VI, LINES 13 & 14 THE HOSPITAL DOES HAVE WRITTEN WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES. HOWEVER, AS OF FYE 6/30/12 THEY HAD NOT BEEN FORMALLY ADOPTED BY THE HOSPITAL'S BOARD OF TRUSTEES. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED FORM 990, PART VI, QUESTION 15A & 15B THE EXECUTIVE COMPENSATION COMMITTEE OF THE BRRH BOARD OF TRUSTEES ANNUALLY REVIEWS COMPENSATION FOR THE PRESIDENT AND CEO AS WELL AS OTHER EXECUTIVES/VPS. THE COMMITTEE DETERMINES THE COMPENSATION FOR THE PRESIDENT AND CEO. THE COMMITTEE ALSO REVIEWS AND APPROVES THE MERIT INCREASES FOR THE EXECUTIVES/VPS AS RECOMMENDED BY THE PRESIDENT AND CEO. THE PROCESS INCLUDES REVIEW OF CURRENT COMPENSATION DATA THAT BENCHMARKS BRRH EXECUTIVE SALARIES WITH OTHER HEALTHCARE ORGANIZATIONS OF A SIMILAR SIZE AND NET REVENUE. THIS REVIEW AND APPROVAL IS DOCUMENTED IN THE EXECUTIVE COMPENSATION COMMITTEE MINUTES AT THE TIME OF THE REVIEW. AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 THE FINANCIAL STATEMENTS ARE AVAILABLE FOR REVIEW ON WWW.DACBOND.COM. THE CONFLICT OF INTEREST POLICIES ARE NOT AVAILABLE TO THE GENERAL PUBLIC. THE GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. HOURS DEVOTED TO RELATED ENTITIES FORM 990, PART VII, SECTION A, COLUMN B ESTIMATED HOURS PER WEEK DEVOTED BY OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES TO RELATED ENTITIES: BRRH HOME HEALTH SERVICES, INC.: JERRY FEDELE - 2 DAWN JAVERSACK - 2 JUDY HLAFCSAK - 2 ALEX EREMIA - 2 HUGH MIDDLEBROOKS - 2 KAREN POOLE - 2 MINDY RAYMOND - 2 BRRH FOUNDATION, INC.: JERRY FEDELE - 2 DAWN JAVERSACK - 2 WARREN ORLANDO - 1 RICHARD SCHMIDT - 1 CHRISTOPHER WHEELER - 1 JUDY HLAFCSAK - 1 HUGH MIDDLEBROOKS - 1 ALEX EREMIA - 1 CHRISTINE E. LYNN - 1 MINDY RAYMOND - 1 DEBBIE LEISING - 1 BRRH CORPORATION, INC. RICHARD L SCHMIDT - 2 CHRISTINE E LYNN - 2 JERRY FEDELE - 2 DAWN JAVERSACK - 2 MARC TAUB, MD - 2 HARVEY SANDLER - 2 CHRISTOPHER WHEELER - 2 RONALD G ASSAF - 2 DONALD KOHNKEN - 2 A.E. "BUD" OSBORNE - 2 ANDREW ROSS, M.D. - 2 MATTHEW KLEIN, MD - 2 DEBBIE LEISING - 2 JUDY HLAFCSAK - 2 WILLIAM HAGER - 2 WARREN ORLANDO - 2 RALPH PALUMBO, MD - 2 HUGH MIDDLEBROOKS - 2 ALEX EREMIA - 2 FUNDRAISING EXPENSES FORM 990, PART IX, COLUMN D The majority of the Hospital's contributions are from related organizations and its affiliate, BRRH Foundation, Inc., provides fundraising for the Hospital and the other members of the BRRH Corporation affiliated group. So there aren't any fundraising expenses to report in Part IX, Column D. OTHER CHANGE IN NET ASSETS FORM 990, PART XI, LINE 5 CHANGE IN PENSION LIABILITY: ($26,646,724) CHANGE IN BENEFICIAL INTEREST IN TEMPORARILY RESTRICTED NET ASSETS OF THE FOUNDATION: $8,529,730 TEMPORARILY RESTRICTED CONTRIBUTIONS, NET OF RELATED EXPENSES: ($24) NET CHANGE IN FUND BALANCE: ($18,117,018) OVERSIGHT OF THE AUDIT, REVIEW OR COMPILATION OF FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE AT THE BRRH CORPORATION, INC. LEVEL IS THE COMMITTEE WITH OVERSIGHT OVER THE CONSOLIDATED AUDIT, WHICH INCLUDES BOCA RATON REGIONAL HOSPITAL, INC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.