Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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 monetary support | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 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...... | 4,313,772 | 5,386,611 | 5,140,076 | 5,963,079 | 7,515,394 | 28,318,932 |
| 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. | 4,313,772 | 5,386,611 | 5,140,076 | 5,963,079 | 7,515,394 | 28,318,932 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 28,318,932 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 4,313,772 | 5,386,611 | 5,140,076 | 5,963,079 | 7,515,394 | 28,318,932 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | |||||
| 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 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 4,313,772 | 5,386,611 | 5,140,076 | 5,963,079 | 7,515,394 | 28,318,932 |




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| MATERIAL DIFFERENCES IN VOTING RIGHTS | FORM 990, PART VI, SECTION A, LINE 1 | THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE, CONSISTING OF THE PRESIDENT AND SECRETARY/TREASURER, WHICH HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS BETWEEN SCHEDULED MEETINGS. |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, SECTION A, LINE 6 | UNITED REGIONAL PHYSICIAN GROUP HAS ONE MEMBER, UNITED REGIONAL HEALTH CARE SYSTEM. |
| MEMBERS OF GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7A | UNITED REGIONAL HEALTH CARE SYSTEM, MAY ELECT OR REMOVE MEMBERS OF THE GOVERNING BODY. |
| DECISIONS THAT REQUIRE APPROVAL | FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER, UNITED REGIONAL CARE SYSTEM HAS FULL AUTHORITY TO ACT ON THE FOLLOWING MATTERS. 1. DEVELOPMENT, APPROVAL, ADOPTION AND MODIFICATION OF ANNUAL CAPITAL AND THE CORPORATION; 2. APPROVAL OF ANY NON-BUDGETED FINANCIAL COMMITMENT BELOW A PREDETERMINED AMOUNT 3. BORROWING OR LENDING OF MONEY OR THE INCURRENCE OR GUARANTEE OF ANY DEBT OR OTHER FINANCIAL OBLIGATION, DIRECTLY OR INDIRECTLY; 4. CREATION, OWNERSHIP, OR ACQUISITION AND DISSOLUTION OF ANY SUBSIDIARIES OF THE CORPORATION; 5. CREATION, OWNERSHIP, ACQUISITION OF OR AFFILIATION WITH, ANY OTHER ORGANIZATION AND THE DISSOLUTION OF OR TERMINATION OF AFFILIATION WITH SUCH ORGANIZATION; 6. ANY ACQUISITION, PURCHASE, SALE, LEASE, MORTGAGE, OR OTHER TRANSFER OF ANY REAL PROPERTY; 7. ANY TRANSFER OF ANY PERSONAL PROPERTY OF THE CORPORATION; 8. ANY DISSOLUTION, MERGER, CONSOLIDATION, SALE, OR OTHER CORPORATE THE CORPORATION; 9. ESTABLISHMENT, MODIFICATION, CARRYING ON AND TERMINATION BY THE CORPORATION OF ANY CORPORATE COMPLIANCE PROGRAM; 10. THE GIVING, SEEKING OR RECEIVING AND OVERSIGHT OF ADMINISTRATION OR USE OF GRANTS AND OTHER CONTRIBUTIONS AND GIFTS; 11. DEVELOP, ADOPT, APPROVE AND AMEND SALARIES AND OTHER COMPENSATION (INCLUDING THE AWARDING OF ANY INCENTIVE COMPENSATION) AND BENEFITS AND THE OTHER TERMS OF EMPLOYMENT OR ENGAGEMENT OF THE OFFICERS AND EMPLOYEES, INCLUDING PHYSICIAN EMPLOYEES OF THE CORPORATION, AND PHYSICIANS WHO ARE INDEPENDENT CONTRACTORS TO THE CORPORATION; 12. THE COMMENCEMENT OR SETTLEMENT OF LITIGATION OR OTHER CLAIMS, OR ALTERNATIVE DISPUTE RESOLUTION, INCLUDING BUT NOT LIMITED TO MEDIATION OR ARBITRATION; 13. ESTABLISHMENT, ADOPTION OR APPROVAL OR AMENDMENT OF FEE SCHEDULES RELATING TO PATIENT SERVICES AND OTHER SERVICES PROVIDED BY THE CORPORATION, ITS EMPLOYEES AND CONTRACTORS; 14. APPROVAL OF ANY MATERIAL CHANGES IN THE SCOPE OF SERVICES OFFERED BY THE CORPORATION, INCLUDING THE RANGE OF PHYSICIAN SPECIALTIES EMPLOYED BY OR CONTRACTED BY THE CORPORATION; 15. APPROVAL OF ANY STRATEGIC PLAN, BUSINESS PLAN, OR MISSION PLAN OF THE CORPORATION; 16. APPOINTMENT AND REMOVAL THE CORPORATION'S DIRECTORS; 17. DETERMINE, AUTHORIZE AND APPROVE CONTRIBUTIONS TO THE MEMBER. OR ANY THAT IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE CODE DELIVERS OR SUPPORTS THE DELIVERY OF HEALTH CARE SERVICES TO THE PUBLIC; 18. THE FILING OF ANY VOLUNTARY PETITION IN BANKRUPTCY OR ANY OTHER OR PLEADING SEEKING ANY REORGANIZATION, SIMILAR RELIEF UNDER FEDERAL OR STATE LAW; 19. APPROVAL OF THE CREATION AND STRUCTURE OPERATING UNITS AND - OF UNIT DIRECTOR. |
| PROCESS OF REVIEW | FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE SECRETARY/TREASURER AND THEN BY THE EXECUTIVE COMMITTEE OF UNITED REGIONAL HEALTH CARE SYSTEM, WHICH HAS BEEN DESIGNATED RESPONSIBILITY BY THE BOARD OF DIRECTORS, PRIOR TO FILING OF RETURN. |
| MONITORING COMPLIANCE | FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED INITIALLY BY THE CHIEF COMPLIANCE OFFICER AND THE CEO FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINE 15A & 15B | UNITED REGIONAL PHYSICIAN GROUP DOES NOT DETERMINE COMPENSATION FOR THE PRESIDENT/CEO AND OTHER OFFICERS. THEIR COMPENSATION IS DETERMINED AND PAID BY UNITED REGIONAL HEALTH CARE SYSTEM, A RELATED ORGANIZATION. THEREFORE, THE ORGANIZATION HAS MARKED QUESTION 15A AS "NO". UNITED REGIONAL HEALTH CARE SYSTEM USES PHYSICIAN COMPENSATION CONSULTANTS AND THE LATEST COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES. COMPENSATION IS ALSO REVIEWED BY THE EXECUTIVE COMMITTEE OF UNITED REGIONAL HEALTH CARE SYSTEM. THE PROCESS FOR DETERMINING COMPENSATION IS PERFORMED ANNUALLY AND DOCUMENTED THROUGH EXCHANGES WITH INDEPENDENT COMPENSATION CONSULTANTS. |
| PUBLIC AVAILABILITY TO DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION RUNS AN AD IN THE LOCAL NEWSPAPER ANNUALLY THAT STATES THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST WITH ADDRESS. OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| COMPENSATION OF OFFICERS AND DIRECTORS | FORM 990, PART VII, SECTION A | DIRECTORS REPORTED IN PART VII, SECTION A ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS NOT AS DIRECTORS. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 | NET CHANGE IN AFFILIATE TRANSFERS $ 1,082,575 |
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