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
ST BERNARDS HEALTHCARE INC
Employer identification number
71-0853900
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......
15,638,578
16,252,952
15,358,322
15,130,032
14,783,080
77,162,964
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.
15,638,578
16,252,952
15,358,322
15,130,032
14,783,080
77,162,964
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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
13,226,428
13,709,975
12,173,252
11,840,386
50,950,041
c
Add lines 7a and 7b..
0
13,226,428
13,709,975
12,173,252
11,840,386
50,950,041
8
Public Support (Subtract line 7c from line 6.)
26,212,923
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...
15,638,578
16,252,952
15,358,322
15,130,032
14,783,080
77,162,964
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
101,606
59,801
49,044
41,608
33,667
285,726
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
101,606
59,801
49,044
41,608
33,667
285,726
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.)
185,181
136,919
208,712
121,627
191,620
844,059
13
Total support (Add lines 9, 10c, 11 and 12.).
15,925,365
16,449,672
15,616,078
15,293,267
15,008,367
78,292,749
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
33.481 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
48.130 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0.365 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0.540 %
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
ST BERNARDS HEALTHCARE INC
Employer identification number
71-0853900
Identifier
Return Reference
Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PAGE 3, PART III(A)
SINCE 1900, ST BERNARDS HAS SERVED AS OUR COMMUNITY'S TRUSTED PROVIDER OF COMPREHENSIVE, COMPASSIONATE HEALTHCARE. WITH OUR DEDICATED AND EXPERIENCED EMPLOYEES, ADVANCED TECHNOLOGY, AND THE LARGEST MEDICAL STAFF IN THE REGION, ST BERNARDS IS THE MEDICAL CENTER OF CHOICE. TODAY, AS WELL AS IN THE FUTURE, ST BERNARDS WILL CONTINUE TO PUT PATIENTS AND COMMUNITY NEEDS FIRST BY FOCUSING ON QUALITY, SAFETY, COST CONTROL, SERVICE AND DIVERSITY. DURING FISCAL YEAR 2012, $29,960,646 WAS SPENT FOR COMMUNITY BENEFIT. 526,782 PERSONS WERE SERVED THROUGH HEALTH SCREENINGS, DONATIONS, EDUCATIONAL CLASSES, AND VOLUNTEER EFFORTS.
MEMBER INFORMATION
FORM 990, PART VI, LINES 6, 7A AND 7B
OLIVETAN BENEDICTINE SISTERS, INC IS THE SOLE MEMBER OF ST. BERNARDS HEALTHCARE, INC. THE DIRECTORS OF THE CORPORATION SHALL AT ALL TIMES INCLUDE SEVEN MEMBERS OF THE MEMBER. OF THESE SEVEN MEMBERS ONE SHALL BE THE PRIORESS OF HOLY ANGELS CONVENT AND ONE SHALL BE THE MEMBER SERVING AS BUSINESS MANAGER OF THE MEMBER. THE MEMBER MUST APPROVE ANY TRANSACTION OVER $1 MILLION. THE DIOCESE OF LITTLE ROCK MUST APPROVE ANY TRANSACTION OVER $5 MILLION. THE MEMBER ALSO RESERVES POWER OVER ANY VARIANCE WITH CONGREGATIONAL POLICY, PHILOSOPHY, OR ETHICS. ANY AMENDMENT, ALTERATION, OR REPEAL OF THE BYLAWS MUST BE APPROVED BY THE MEMBER. THE MEMBER ALSO RESERVES POWER TO REMOVE ANY MEMBER OF THE GOVERNING BOARD IF IN THE SOLE DISCRETION OF THE MEMBER THE GOVERNING BOARD MEMBER ACTS AT VARIANCE WITH CONGREGATIONAL POLICY, PHILOSOPHY, OR THE ETHICS OF THE MEMBER.
REVIEW PROCEDURES FOR FORM 990
FORM 990, PART VI, SECTION B, LINE 11B
THE FORM 990 IS REVIEWED BY THE FOLLOWING PERSONS OR GROUPS: CONTROLLER OF ST. BERNARDS HEALTHCARE, INC., VICE PRESIDENT OF FINANCE OF ST. BERNARDS HEALTHCARE, INC., PRESIDENT/CEO OF ST. BERNARDS HEALTHCARE, INC., LEGAL COUNSEL, AND THE AUDIT COMMITTEE OF ST. BERNARDS HEALTHCARE, INC. PRIOR TO FILING.
CONFLICT OF INTEREST MONITORING PROCEDURES
FORM 990, PART VI, LINE 12C
DIRECTORS AND ABOVE ANNUALLY SUBMIT A WRITTEN STATEMENT DISCLOSING ANY POTENTIAL CONFLICTS OF INTEREST. MANAGEMENT INVESTIGATES ANY POTENTIAL CONFLICTS AND TAKES APPROPRIATE ACTION DEPENDING ON THE NATURE OF THE CONFLICT. LEGAL COUNSEL ALSO REVIEWS ANY POTENTIAL CONFLICTS OF INTEREST AND ADVISES MANAGEMENT.
COMPENSATION REVIEW PROCEDURES
FORM 990, PART VI, LINE 15A & 15B
THE CHAIRPERSON OF THE BOARD OF DIRECTORS SELECTS PERSONS TO SERVE ON THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE APPROVES THE INITIAL SALARY AND ANY SUBSEQUENT SALARY ADJUSTMENTS OF ALL MANAGEMENT. THE COMPENSATION COMMITTEE OBTAINS AN INDEPENDENT SALARY SURVEY FROM CLARK CONSULTING ON AN ANNUAL BASIS FOR USE IN DETERMINING THE APPROPRIATE SALARY RANGES FOR MANAGEMENT. THE COMPENSATION COMMITTEE PRESENTS THE INFORMATION TO THE BOARD FOR APPROVAL. IN 2009, COMPENSATION OF ALL MANAGEMENT PERSONNEL AND ALL OTHER EMPLOYEES OF THE ORGANIZATION WAS REVIEWED BY CLARK CONSULTING.
PARTICIPATION IN JOINT VENTURES
FORM 990, PART VI, LINE 16B
ST. BERNARDS HEALTHCARE, INC. IS IN THE PROCESS OF IMPLEMENTING A POLICY TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS. ALL OPERATING AGREEMENTS OF JOINT VENTURE ARRANGEMENTS CONTAIN A CLAUSE THAT SAFEGUARDS THE ORGANIZATION'S EXEMPT STATUS.
AVAILABILITY OF GOVERNING DOCUMENTS
FORM 990, PART VI, LINE 19
THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC.
OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
TRANSFER FROM AFFILIATES $5,498,332 BOOK TO TAX DIFFERENCE ON PAIN CENTER, LLC K-1 (7,041) ALLCARE OF ARKANSAS K-1 INCOME (550,972) ---------- 4,940,319
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.