TY 2011 Form 990

- TIN:

Form990

Department of the Treasury
Internal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

2011

Open to Public Inspection

A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012

BCheck if applicable: Address change Name change Initial return Terminated Amended return Application pending

CName of organization
UNIVERSITY COMMUNITY HEALTH SERVICES INC

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address)
2410 Franklin Road

Room/suite

City or town, state or country, and ZIP + 4
Nashville, TN37204

D Employer identification number

62-1438461

E Telephone number

G Gross receipts $ 7,556,073

F Name and address of principal officer:
BARBARA SNELL
2410 Franklin Road
Nashville,TN37204

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.UCHSHEALTH.ORG

H(a)

Is this a group return for
affiliates? Yes No

H(b)

Are all affiliates included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1990

M State of legal domicile: TN

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE ACCESSIBLE AFFORDABLE, HOLISTIC HEALTHCARE TO PATIENTS ACROSS THE LIFESPAN WITH A SPECIAL FOCUS ON VULNERABLE POPULATIONS, WITHIN A FINANCIALLY SUSTAINABLE DELIVERY MODEL. FURTHER, UCHS SUPPORTS HEALTH PROFESSIONS EDUCATION, CLINICAL AND HEALTH SERVICES RESEARCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	12
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	76
6	Total number of volunteers (estimate if necessary) ....	6	18
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,034,089	823,412
9	Program service revenue (Part VIII, line 2g) .........	7,136,243	6,732,624
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	101	37
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	103,524	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	8,273,957	7,556,073
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	2,301,650	2,641,123
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	5,102,427	5,153,737
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	7,404,077	7,794,860
19	Revenue less expenses. Subtract line 18 from line 12.......	869,880	-238,787
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	3,290,287	3,273,199
21	Total liabilities (Part X, line 26).............	592,112	813,811
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,698,175	2,459,388

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid preparer use only

Print/type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image

Firm's address Right pointing arrowhead image

Phone no.

May the IRS discuss this return with the preparer shown above? See instructions ......... bullet

YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y

Form 990 (2011)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response to any question in this Part III .........

Briefly describe the organization’s mission: TO PROVIDE ACCESSIBLE, AFFORDABLE, HOLISTIC HEALTHCARE TO PATIENTS ACROSS THE LIFESPAN WITH A SPECIAL FOCUS ON VULNERABLE POPULATIONS, WITHIN A FINANCIALLY SUSTAINABLE DELIVERY MODEL. FURTHER, UCHS SUPPORTS HEALTH PROFESSIONS EDUCATION, CLINICAL, AND HEALTH SERVICES RESEARCH.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .................... Yes No

If “Yes,” describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? .......................... Yes No

If “Yes,” describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 6,510,630 including grants of $ ) (Revenue $ 6,732,624 )
	UNIVERSITY COMMUNITY HEALTH SERVICES OPERATES A NETWORK OF NURSE MANAGED PRIMARY CARE CLINICS WHICH ARE PRIMARILY LOCATED IN LOW INCOME AREAS. THE PATIENTS REPRESENT A VULNERABLE POPULATION WITH THE MAJORITY COVERED BY TENNCARE OR WITHOUT INSURANCE. THE NETWORK PROVIDED OVER 56,210 VISITS DURING THE YEAR ENDED JUNE 30, 2012. THESE CLINICS PROVIDE VITAL HEALTH SERVICES TO THIS UNDERSERVED POPULATION. THE CLINICS ARE PART OF THE STATE SAFETY NET NETWORK AND SERVICES PROVIDED TO THE UNINSURED ARE UNDER AN AFFORDABLE SLIDING SCALE.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 6,510,630

Form 990 (2011)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A Click to see attachment

.....................

Yes

Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment

........

Yes

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........

Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I....................

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................

Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V

If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:

Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI. Click to see attachment

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.

11d

Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.

11e

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X. Click to see attachment

11f

Yes

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment

12a

Yes

Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional

12b

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States?....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..

Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................

20a

Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....

20a

If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.

20b

Form 990 (2011)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....

Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................

24c

Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................

25b

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................

28a

A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..

28c

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............

Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........

Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1.....................

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...

35b

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Form 990 (2011)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response to any question in this Part V .........

Yes

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?.............................

If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........

If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................

If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................

If “Yes,” indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............

Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?.........

Did the organization make a distribution to a donor, donor advisor, or related person?......

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.

13a

Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.

13b

Enter the aggregate amount of reserves on hand.

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..

14b

Form 990 (2011)

Page 6

Part VI

Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response to any question in this Part VI .........

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent .................

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?

Yes

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .........................

Yes

Each committee with authority to act on behalf of the governing body? ..........

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....

Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

11a

Yes

Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....

12a

Did the organization have a written conflict of interest policy? If “No,” go to line 13.......

12a

Yes

Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Other officers or key employees of the organization ................

15b

If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request

Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet

Ira Jones
2410 Franklin Road
Nashville,TN37204
(615) 932-7634

Form 990 (2011)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response to any question in this Part VII .........

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) CLARE THOMSON-SMITH PARTIAL YEAR BOARD MEMBER SECRETARY	1.00	X	X	0	0	0
(2) DAVID MILLS PARTIAL YEAR BOARD MEMBER VP	1.00	X	X	0	0	0
(3) J RICHARD WAGERS JR BOARD MEMBER TREASURER	1.00	X	X	0	0	0
(4) MICHAEL MCKEE BOARD MEMBER VP	1.00	X	X	0	0	0
(5) RACHEL ODOM BOARD MEMBER SECRETARY	1.00	X	X	0	0	0
(6) RONALD W HILL BOARD MEMBER PRESIDENT	1.00	X	X	0	0	0
(7) ANTHONY REDMON PARTIAL YEAR BOARD MEMBER	1.00	X		0	0	0
(8) BARBARA CANNON BOARD MEMBER	1.00	X		0	0	0
(9) BONITA PILON PARTIAL YEAR BOARD MEMBER	1.00	X		0	0	0
(10) COLLEEN M CONWAY-WELCH BOARD MEMBER	1.00	X		0	0	0
(11) DAVID POSCH PARTIAL YEAR BOARD MEMBER	1.00	X		0	0	0
(12) DONALD SHAH BOARD MEMBER	1.00	X		0	0	0
(13) FATHER JOSEPH PATRICK BREEN BOARD MEMBER	1.00	X		0	0	0
(14) JOHN WALKER PARTIAL YEAR BOARD MEMBER	1.00	X		0	0	0
(15) KAREN NANNEY BOARD MEMBER	1.00	X		0	0	0
(16) LAVERDIA MCCULLOUGH BOARD MEMBER	1.00	X		0	0	0
(17) PAUL STERNBERG BOARD MEMBER	1.00	X		0	0	0

Form 990 (2011)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) SHIRLEY CALDWELL ALDRICH BOARD MEMBER	1.00	X			0	0	0
(19) BARBARA SNELL CEO	40.00		X		122,939	0	10,438
(20) IRA JONES CFO	40.00		X		117,928	0	7,253
(21) SAMUEL T ROSENBLOOM CHIEF MEDICAL OFFICER	10.00		X		26,896	0	0
(22) ANISSA BURGESS DDS PHYSICIAN	40.00			X	101,813	0	7,492
(23) LILLIAN N SAILORS MD PHYSICIAN	40.00			X	110,942	0	12,347

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	480,518	0	37,530

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

Form 990 (2011)

Page 9

Part VIII

Statement of Revenue

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		815,494

f	All other contributions, gifts, grants, and similar amounts not included above1f		7,918
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			823,412
			Business Code
2a	PATIENT SERVICE FEES		900,099	6,571,270	6,571,270
b	OFFSITE EXAMS		900,099	72,800	72,800
c	EMPLOYEE PHYSICALS		900,099	25,680	25,680
d	COST REPORT SETTLEMENT		900,099	14,290	14,290
e	CAPITATION FEES		900,099	6,499	6,499
f	All other program service revenue .			42,085	42,085	0	0
g	Total. Add lines 2a–2f........			6,732,624
3	Investment income (including dividends, interest
	and other similar amounts).....			37			37
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	0
d	Net gain or (loss)..........			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions....			7,556,073	6,732,624	0	37

Form 990 (2011)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	205,424		205,424
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	1,849,202	1,641,677	207,525
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	33,090	26,489	6,601
9	Other employee benefits .......	368,137	266,581	101,556
10	Payroll taxes ...........	185,270	131,485	53,785
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	11,462		11,462
c	Accounting ...........	46,440		46,440
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	0
g	Other ..........	3,570,177	3,278,362	291,815
12	Advertising and promotion ....	49,581	33,153	16,428
13	Office expenses .......	58,787	47,098	11,689
14	Information technology ......	234,749	73,371	161,378
15	Royalties ..	0
16	Occupancy ...........	224,948	187,644	37,304
17	Travel ............	18,093	15,145	2,948
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	219,684	219,684
23	Insurance ..............	51,033		51,033
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	MEDICAL SUPPLIES & SERVICES	490,772	490,768	4
b	OTHER SUPPLIES	64,237	46,929	17,308
c	EQUIPMENT RENTAL	21,031	15,496	5,535
d	EDUCATION & TRAINING	15,092	11,807	3,285
e
f	All other expenses	77,651	24,941	52,710	0
25	Total functional expenses. Add lines 1 through 24f	7,794,860	6,510,630	1,284,230	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).	0

Form 990 (2011)

Page 11


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			757	1	1,006
2	Savings and temporary cash investments .......			516,507	2	1,189,872
3	Pledges and grants receivable, net .........			1,103,130	3	375,870
4	Accounts receivable, net .........			466,996	4	483,483
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............				8
9	Prepaid expenses and deferred charges ............			41,277	9	64,583
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,196,000
b	Less: accumulated depreciation. .....	10b	1,037,615	1,161,620	10c	1,158,385
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)...			3,290,287	16	3,273,199
17	Accounts payable and accrued expenses .			563,053	17	783,269
18	Grants payable ..........				18
19	Deferred revenue ..........			29,059	19	30,542
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			0	25	0
26	Total liabilities. Add lines 17 through 25.....			592,112	26	813,811
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			2,698,175	27	2,459,388
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			2,698,175	33	2,459,388
34	Total liabilities and net assets/fund balances .....			3,290,287	34	3,273,199

Form 990 (2011)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI .........

Total revenue (must equal Part VIII, column (A), line 12) ...

7,556,073

Total expenses (must equal Part IX, column (A), line 25) ....

7,794,860

Revenue less expenses. Subtract line 2 from line 1 ...

-238,787

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

2,698,175

Other changes in net assets or fund balances (explain in Schedule O) ...

Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....

2,459,388

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII .........

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?....

Were the organization’s financial statements audited by an independent accountant?........

Yes

If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................

Yes

If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separated basis

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................

Yes

If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..

Yes

Form 990 (2011)

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

UNIVERSITY COMMUNITY HEALTH SERVICES INC

Employer identification number

62-1438461

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

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).

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 ..................................................

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

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

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).

Gross receipts from related activities, etc. (See instructions.) ..................

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.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

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 ...................... right arrow

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 ..................... right arrow

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 .................................................. right arrow

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 .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

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.") .	2,644,624	5,156,700	5,911,803	4,597,259	823,412	19,133,798
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......	2,613,508	2,454,742	2,155,246	3,477,933	6,732,624	17,434,053
3	Gross receipts from activities that are not an unrelated trade or business under section 513..						0
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge..						0
6	Total. Add lines 1 through 5.	5,258,132	7,611,442	8,067,049	8,075,192	7,556,036	36,567,851
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	0	0	0	0	0
8	Public Support (Subtract line 7c from line 6.)						36,567,851

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...	5,258,132	7,611,442	8,067,049	8,075,192	7,556,036	36,567,851
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..		464	414	101	37	1,016
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	0	464	414	101	37	1,016
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.						0
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)	0	0	131,472	198,664	0	330,136
13	Total support (Add lines 9, 10c, 11 and 12.).	5,258,132	7,611,906	8,198,935	8,273,957	7,556,073	36,899,003

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

99.100 %

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

98.930 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

0 %

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

0.040 %

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 .......... right arrow

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 .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

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
OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - , COLUMN A - , COLUMN B - , COLUMN C - 131472, COLUMN D - 198664, COLUMN E - , COLUMN F - 330136;,

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

UNIVERSITY COMMUNITY HEALTH SERVICES INC

Employer identification number

62-1438461

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization UNIVERSITY COMMUNITY HEALTH SERVICES INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization UNIVERSITY COMMUNITY HEALTH SERVICES INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
UNIVERSITY COMMUNITY HEALTH SERVICES INC

Employer identification number

62-1438461

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

UNIVERSITY COMMUNITY HEALTH SERVICES INC

Employer identification number

62-1438461

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................			0
b	Buildings ................			0
c	Leasehold improvements ............	1,523,150	667,590	855,560
d	Equipment ................	672,850	370,025	302,825
e	Other .................			0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				1,158,385

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		0
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	7,556,073
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	7,794,860
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-238,787
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	0
9	Total adjustments (net). Add lines 4 through 8 .........................	9	0
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-238,787

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	7,581,955
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b	25,882
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d	0
e	Add lines 2a through 2d .....................			2e	25,882
3	Subtract line 2e from line 1.....................			3	7,556,073
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	7,556,073

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	7,820,742
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	25,882
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d	0
e	Add lines 2a through 2d......................			2e	25,882
3	Subtract line 2e from line 1.....................			3	7,794,860
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	7,794,860

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
FIN 48 (ASC 740) footnote	Schedule D, Part X, Line 2	THE ORGANIZATION IS EXEMPT FROM INCOME TAXES ON INCOME FROM RELATED ACTIVITIES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. DUE TO ITS TAX-EXEMPT STATUS, THE ORGANIZATION IS GENERALLY NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE ORGANIZATION'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF TENNESSEE FOR THE LAST THREE YEARS. THE ORGANIZATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE ORGANIZATION DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT JUNE 30, 2012 AND 2011.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0

- 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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

UNIVERSITY COMMUNITY HEALTH SERVICES INC

Employer identification number

62-1438461

Identifier	Return Reference	Explanation
Significant changes to organizational documents	Form 990, Part VI, Section A, Line 4	ARTICLE II PURPOSE WAS UPDATED: "A. THE CORPORATION IS A NONPROFIT PUBLIC BENEFIT CORPORATION AND IS NOT ORGANIZED FOR THE PRIVATE GAIN OF ANY PERSON. B. THE SPECIFIC PURPOSES OF THE CORPORATION ARE: 1. TO PROVIDE OUTPATIENT PRIMARY HEALTH SERVICE IN UNDER-SERVED AREAS FOR MEDICALLY UNDER-SERVED POPULATIONS AS A COMMUNITY CLINIC. 2. TO DEVELOP, PROMOTE, AND MANAGE HEALTH CARE FACILITIES, SERVICES, AND PROGRAMS WITH EMPHASIS ON COMPREHENSIVE HEALTH CARE, PREVENTATIVE MEDICINE AND HEALTH MAINTENANCE. 3. TO EDUCATE THE PUBLIC IN THE PRINCIPLES OF HEALTH PROTECTION AND PROMOTE OTHER PROJECTS IN THE INTEREST OF THE PUBLIC'S HEALTH. 4. TO PROMOTE MUTUALLY ACCEPTABLE AND SATISFYING RELATIONSHIPS BETWEEN THE CORPORATION AND OTHER PROVIDERS OF HEALTH CARE SO AS TO DEVELOP AN EFFICIENT AND EFFECTIVE DELIVERY OF HEALTH CARE. 5. TO PARTICIPATE IN AND COOPERATE WITH ANY GOVERNMENTAL AGENCY OR OTHER ORGANIZATION ENGAGED IN SIMILAR OR LIKE ACTIVITIES. 6. TO ENGAGE IN HEALTH PROFESSIONS TRAINING. 7. TO ENGAGE IN SUCH OTHER ACTIVITIES AS DIRECTED BY THE BOARD SUCH AS HEALTH CARE RESEARCH. ARTICLE III BOARDS OF DIRECTORS WAS UPDATED: A. POWERS THE ACTIVITIES AND AFFAIRS OF THE CORPORATION SHALL BE CONDUCTED AND ALL CORPORATE POWERS SHALL BE EXERCISED BY OR UNDER THE DIRECTION OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL EMPLOY A CHIEF EXECUTIVE OFFICER WHO SHALL BE RESPONSIBLE FOR THE MANAGEMENT OF THE CORPORATION'S BUSINESS AND IMPLEMENT THE POLICIES ADOPTED BY THE BOARD OF DIRECTORS. IN ADDITION TO GENERAL POWERS AND RESPONSIBILITIES, THE BOARD SHALL HAVE THE SPECIFIC RESPONSIBILITY FOR: 1. APPROVAL FOR THE SELECTION AND DISMISSAL OF THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. 2. ESTABLISHING PERSONNEL POLICIES AND PROCEDURES INCLUDING SELECTION AND DISMISSAL PROCEDURES, EMPLOYEE GRIEVANCE PROCEDURES, AND EQUAL OPPORTUNITY PRACTICES. 3. ADOPTING POLICIES FOR FINANCIAL MANAGEMENT PRACTICES, INCLUDING ARRANGING FOR AN ANNUAL INDEPENDENT AUDIT, A SYSTEM TO ASSURE ACCOUNTABILITY FOR CORPORATE RESOURCES, APPROVAL OF THE ANNUAL CORPORATE BUDGET, CORPORATE PRIORITIES, STRATEGIC PLANNING, ELIGIBILITY FOR SERVICES, INCLUDING CRITERIA FOR PARTIAL PAYMENT SCHEDULES, AND LONG-RANGE FINANCIAL PLANNING; 4. EVALUATING CORPORATE ACTIVITIES INCLUDING SERVICES UTILIZATION PATTERNS, PRODUCTIVITY, PATIENT SATISFACTION, ACHIEVEMENT OF OBJECTIVES, AND DEVELOPMENT OF PROCESS FOR HEARING AND RESOLVING PATIENT GRIEVANCES; 5. ASSURING THAT THE CORPORATION IS OPERATED IN COMPLIANCE WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS; AND 6. ADOPTING HEALTH CARE POLICIES INCLUDING SCOPE AND AVAILABILITY OF SERVICES, LOCATION, AND HOURS OF SERVICES, AND QUALITY-OF-CARE AUDIT PROCEDURES. B. CLASSES OF BOARD MEMBERS BOARD MEMBERS SHALL BE CATEGORIZED INTO ONE OF THE FOLLOWING THREE CATEGORIES: 1. CONSUMER MEMBERS: CONSUMER MEMBERS ARE ALL MEMBERS OF THE BOARD WHO ARE SERVED BY THE CORPORATION AND WHO, AS A GROUP, REPRESENT THE INDIVIDUALS BEING SERVED IN TERMS OF DEMOGRAPHIC FACTORS, SUCH AS RACE, ETHNIC BACKGROUND, AND SEX. 2. PROVIDER MEMBERS: PROVIDER MEMBERS ARE ALL MEMBERS EXCEPT CONSUMER AND COMMUNITY MEMBERS, WHO DERIVE MORE THAN TEN PERCENT (10%) OF THEIR ANNUAL INCOME FROM THE HEALTH CARE INDUSTRY; AND 3. COMMUNITY MEMBERS: COMMUNITY MEMBERS ARE REPRESENTATIVES OF THE COMMUNITY AND SHALL BE SELECTED FOR THEIR EXPERTISE IN RELEVANT SUBJECT AREAS, SUCH AS COMMUNITY AFFAIRS, LOCAL GOVERNMENT, FINANCE AND BANKING, LEGAL AFFAIRS, TRADE UNIONS, AND OTHER COMMERCIAL AND INDUSTRIAL CONCERNS OR SOCIAL SERVICES WITHIN THE COMMUNITY AND WHO ARE NEITHER CONSUMER NOR PROVIDER MEMBERS. C. NUMBER, TERM, NOMINATION, ELECTION, QUALIFICATION, AND CONFLICTS OF INTEREST. 1. NUMBER. THE BOARD OF DIRECTORS SHALL CONSIST OF NOT FEWER THAN NINE (9) OR GREATER THAN FIFTEEN (15) DIRECTORS. SUBJECT TO THE PROVISIONS OF SUBSECTION (C)(3), THE EXACT NUMBER WITHIN SUCH MAXIMUM AND MINIMUM NUMBERS SHALL BE DETERMINED FROM TIME TO TIME BY RESOLUTION ADOPTED BY A MAJORITY OF THE ENTIRE BOARD OF DIRECTORS. 2. COMPOSITION OF BOARD. A MAJORITY (AT LEAST 51%) OF THE BOARD SHALL BE CONSUMER MEMBERS AND OF THE NON-CONSUMER MEMBERS NO MORE THAN ONE-HALF SHALL BE PROVIDER MEMBERS. 3. INCREASE IN NUMBER. THE NUMBER OF MEMBERS OF THE BOARD OF DIRECTORS MAY BE INCREASED FROM TIME TO TIME UPON THE AFFIRMATIVE VOTE OF A MAJORITY OF THE ENTIRE BOARD. IF THE NUMBER OF DIRECTORS IS INCREASED BY THE BOARD, A VACANCY OR VACANCIES CAUSED BY SUCH INCREASE SHALL BE FILLED IN ACCORDANCE WITH THE PROVISIONS OF THESE BYLAWS. 4. DECREASE IN NUMBER. THE NUMBER OF MEMBERS OF THE BOARD OF DIRECTORS MAY BE DECREASED BY A MAJORITY VOTE OF DIRECTORS PRESENT AT A MEETING OF THE BOARD. (CONTINUED IN SCHEDULE O)
AMENDED BYLAWS	FORM 990, PART VI, LINE 4	5. TERM. EACH DIRECTOR SHALL SERVE FOR A TERM OF THREE CALENDAR YEARS. DIRECTORS MAY BE ELECTED TO SERVE TWO (2) CONSECUTIVE THREE (3) YEAR TERMS BEFORE ROTATING OFF THE BOARD FOR A PERIOD OF NO LESS THAN TWO (2) YEARS BEFORE STANDING FOR RE-ELECTION TO THE BOARD. BOARD TERMS SHALL BE STAGGERED SUCH THAT EACH YEAR ONE-THIRD OF THE MEMBERSHIP OF THE BOARD IS UP FOR RE-ELECTION, DIVIDED AS EQUALLY AS POSSIBLE AMONG CONSUMER, COMMUNITY AND PROVIDER REPRESENTATIVES. UPON ADOPTION OF THESE AMENDED BYLAWS, THE NOMINATING COMMITTEE SHALL RECOMMEND TO THE FULL BOARD STAGGERED TERMS FROM AMONG THE EXISTING MEMBERSHIP OF THE BOARD OF ONE, TWO AND THREE YEARS TERMS. 6. NOMINATION AND ELECTION OF DIRECTORS. A. THE NOMINATIONS COMMITTEE SHALL NOMINATE A SLATE OF NOMINEES FOR DIRECTORS EQUAL TO THE NUMBER OF DIRECTORSHIPS THAT ARE VACANT OR WILL BECOME VACANT. B. THE NOMINATIONS COMMITTEE SHALL SUBMIT TO THE SECRETARY ITS NOMINATIONS FOR DIRECTORS, AND THE SECRETARY SHALL IMMEDIATELY INFORM THE BOARD OF DIRECTORS OF THE NOMINATIONS, WHICH SHALL BE SUBMITTED NOT LESS THAN FOURTEEN (14) DAYS BEFORE THE ANNUAL BOARD MEETING AT WHICH THE ELECTION WILL OCCUR. ANY DIRECTOR MAY SUBMIT NAMES OF ONE OR MORE OTHER CANDIDATES FOR DIRECTOR POSITIONS, A SEPARATE VOTE WILL BE TAKEN FOR EACH DIRECTORSHIP TO BE FILLED. EACH DIRECTORSHIP SHALL BE FILLED BY A MAJORITY VOTE OF THOSE DIRECTORS PRESENT. NO NOMINEE MAY BE ELECTED IF THE EFFECT OF SUCH ELECTION WOULD BE TO CAUSE THE COMPOSITION OF THE BOARD TO BE IN VIOLATION OF THE REQUIREMENTS CONTAINED IN SUBSECTION (C)(2). 8. CONFLICTS OF INTEREST. A CONFLICT OF INTEREST SHALL BE CONSIDERED TO ARISE WHEN ANY MATTER UNDER CONSIDERATION BY THE BOARD OF DIRECTORS INVOLVES THE POTENTIAL OF SIGNIFICANT OR MATERIAL DIRECT OR INDIRECT BENEFIT FOR A DIRECTOR. THE BOARD OF DIRECTORS SHALL ADOPT A POLICY ACCORDING TO WHICH IT SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS REGARDING A MATTER WHICH COMES BEFORE THE BOARD AND HOW SUCH MATTER SHALL BE CONSIDERED BY THE BOARD. EACH DIRECTOR WILL COMPLETE A CONFLICT OF INTEREST DECLARATION ANNUALLY WHICH DISCLOSURE STATEMENT WILL BE KEPT ON FILE AT THE CORPORATE OFFICE. ARTICLE V OFFICERS A. OFFICERS OF THE CORPORATION. THE OFFICERS OF THE CORPORATION SHALL BE A PRESIDENT, VICE PRESIDENT (PRESIDENT ELECT), SECRETARY, IMMEDIATE PAST PRESIDENT, AND TREASURER. B. ELECTION AND TERM OF OFFICE. THE OFFICERS SHALL BE ELECTED ANNUALLY BY THE BOARD OF DIRECTORS AT THE ANNUAL MEETING OF THE BOARD. EACH OFFICER SHALL SERVE FOR A ONE (1) YEAR TERM AND MAY SERVE NO MORE THAN TWO (2) CONSECUTIVE TERMS. THE OFFICERS OF THE CORPORATION SHALL EXERCISE SUCH POWERS AND PERFORM SUCH DUTIES AS ARE SPECIFIED IN THESE BYLAWS OR ARE FROM TIME TO TIME CONFERRED BY THE BOARD OF DIRECTORS. OTHER THAN THE VICE PRESIDENT AND IMMEDIATE PAST PRESIDENT, NO OFFICER SHALL SUCCEED TO ANOTHER OFFICE. E. EMPLOYED OFFICERS. 1. CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION SHALL BE APPOINTED OR DISMISSED BY THE BOARD OF DIRECTORS, SERVING AT THE PLEASURE OF THE BOARD; SHALL BE A NON-VOTING EX-OFFICIO MEMBER OF THE BOARD OF DIRECTORS; AS THE GENERAL MANAGER OF THE CORPORATION SHALL DIRECT ALL OPERATIONS; SHALL SELECT, SUPERVISE, AND DISMISS ALL PERSONNEL; AND SHALL HAVE CONTROL AND MANAGEMENT OF ITS BUSINESS AND AFFAIRS, ALL SUBJECT TO THE POLICY DIRECTIONS OF THE BOARD OF DIRECTORS. THE BOARD SHALL EVALUATE THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER ANNUALLY, AGAINST A SET OF WRITTEN, AGREED UPON GOALS AND OBJECTIVES. 2. CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER SHALL SERVE AT THE PLEASURE OF THE CHIEF EXECUTIVE OFFICER, AND SHALL BE A NON-VOTING EX-OFFICIO MEMBER OF THE BOARD OF DIRECTORS. THE CHIEF FINANCIAL OFFICER SHALL DISBURSE OR CAUSE TO BE DISBURSED THE FUNDS OF THE CORPORATION AS REQUIRED IN THE ORDINARY COURSE OF BUSINESS OR AS MAY BE ORDERED BY THE BOARD, TAKING PROPER VOUCHERS FOR SUCH DISBURSEMENTS, AND SHALL RENDER TO THE PRESIDENT AND DIRECTORS AT THE REGULAR MEETINGS OF THE BOARD, OR WHENEVER THEY MAY REQUIRE IT, AN ACCOUNT OF ALL OF HIS/HER TRANSACTIONS AS CHIEF FINANCIAL OFFICER AND THE FINANCIAL CONDITION OF THE CORPORATION. HE/SHE SHALL PERFORM SUCH OTHER DUTIES AS MAY BE INCIDENT TO HIS/HER OFFICE OR AS PRESCRIBED FROM TIME TO TIME BY THE BOARD OF DIRECTORS. THE CHIEF EXECUTIVE OFFICER SHALL EVALUATE THE PERFORMANCE OF THE CHIEF FINANCIAL OFFICER ANNUALLY, AGAINST A SET OF WRITTEN, AGREED UPON GOALS AND OBJECTIVES. 3. CHIEF MEDICAL OFFICER. THE CHIEF MEDICAL OFFICER OF THE CORPORATION SHALL OVERSEE ALL MEDICAL ASPECTS OF THE CORPORATION'S ACTIVITIES. HE OR SHE SHALL HAVE SUCH GENERAL POWERS AND DUTIES USUALLY VESTED IN THE CHIEF MEDICAL OFFICER OF A CORPORATION ENGAGED IN THE DELIVERY OF HEALTH CARE SERVICES AND SHALL HAVE SUCH OTHER POWERS AND DUTIES AS MAY BE ASSIGNED BY THE CHIEF EXECUTIVE OFFICER. THE CHIEF MEDICAL OFFICER SHALL BE DIRECTLY EMPLOYED BY THE CORPORATION AND SHALL REPORT DIRECTLY TO THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER SHALL EVALUATE THE ADMINISTRATIVE PERFORMANCE OF THE CHIEF MEDICAL OFFICER ANNUALLY, AGAINST A SET OF WRITTEN, AGREED UPON GOALS AND OBJECTIVES. THE CHIEF MEDICAL OFFICER SHALL OVERSEE COMPLIANCE WITH THE QUALITY IMPROVEMENT INITIATIVES AS SET FORTH THE QUALITY IMPROVEMENT PLAN INCLUDING FEDERALLY MANDATED REPORTING, AND PERFORM SUCH OTHER DUTIES AS MAY BE INCIDENT TO HIS/HER OFFICE OR AS PRESCRIBED FROM TIME TO TIME BY THE BOARD OF DIRECTORS. ARTICLE IX AMENDMENT OF BYLAWS AND CHARTER A. AMENDMENT OF BYLAWS. THESE BYLAWS MAY BE AMENDED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS WHO ARE PRESENT AT ANY REGULAR OR SPECIAL MEETING; PROVIDED, HOWEVER, THAT ANY AMENDMENT TO THESE BYLAWS CHANGING THE NUMBER OF DIRECTORS, IF ADOPTED BY THE BOARD OF DIRECTORS, SHALL REQUIRE THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS OF THE ENTIRE BOARD OF DIRECTORS. NOTICE OF ANY PROPOSED AMENDMENT TO THE BY-LAWS MUST BE GIVEN AT LEAST THIRTY (30) DAYS BEFORE THE MEETING AT WHICH SUCH AMENDMENT WILL BE CONSIDERED. B. AMENDMENT OF CHARTER. THE CHARTER MAY BE AMENDED BY THE AFFIRMATIVE VOTE OF A TWO-THIRDS (2/3) OF THE MEMBERS OF THE BOARD OF DIRECTORS. NOTICE OF ANY PROPOSED AMENDMENT TO THE CHARTER MUST BE GIVEN AT LEAST THIRTY (30) DAYS BEFORE THE MEETING AT WHICH SUCH AMENDMENT WILL BE CONSIDERED.
Review of form 990 by governing body	Form 990, Part VI, Section B, Line 11b	THE CFO AND CEO REVIEW THE FORM 990. BEFORE THE FORM 990 IS FILED WITH THE IRS, THE CFO AND CEO DISTRIBUTE THE FORM AND PRESENT IT TO THE BOARD FOR APPROVAL.
Conflict of interest policy	Form 990, Part VI, Section B, Line 12c	THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REQUIRED FOR ALL BOARD MEMBERS AND OFFICERS TO SIGN A STATEMENT AFFIRMING THAT THEY HAVE NO CONFLICTS OF INTEREST WITH THE ORGANIZATION. THE CEO MONITORS THE CONFLICT OF INTEREST STATEMENTS AND NOTIFIES THE BOARD IN THE EVENT A POTENTIAL CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER IS EXCLUDED FROM PARTICIPATING IN THE DELIBERATIONS OF THE TRANSACTION.
Governing documents, conflict of interest policy and financial statements available to the public	Form 990, Part VI, Section C, Line 19	FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000230
Software Version:	v2011.1.0