Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
United Regional Physician Group
Employer identification number
75-2925491
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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......
5,386,611
5,140,076
5,963,079
7,515,394
10,552,160
34,557,320
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.
5,386,611
5,140,076
5,963,079
7,515,394
10,552,160
34,557,320
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.)
34,557,320
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
5,386,611
5,140,076
5,963,079
7,515,394
10,552,160
34,557,320
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.)..
5,386,611
5,140,076
5,963,079
7,515,394
10,552,160
34,557,320
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
100.000 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
100.000 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0 %
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
United Regional Physician Group
Employer identification number
75-2925491
Return Reference
Explanation
FORM 990, PART VI, section a, Line 1A
Delegation of Authority: 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.
FORM 990, PART VI, section a, line 6
CLASSES OF MEMBERS OR STOCKHOLDERS: UNITED REGIONAL PHYSICIAN GROUP HAS ONE MEMBER, UNITED REGIONAL HEALTH CARE SYSTEM.
FORM 990, PART VI, section a, line 7A
Power to ELECT or appoint MEMBERS OF THE GOVERNING BODY: UNITED REGIONAL HEALTH CARE SYSTEM MAY ELECT OR REMOVE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, section a, line 7B
Decisions of the governing body subject to approval: THE SOLE MEMBER, UNITED REGIONAL HEALTH CARE SYSTEM HAS FULL AUTHORITY TO ACT ON THE FOLLOWING MATTERS: 1. DEVELOPMENT, APPROVAL, ADOPTION AND MODIFICATION OF ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; 2. Approval of any financial commitment, obligation or expenditure by the Corporation of any non-budgeted amount, or of any amount that is in excess of an amount approved in an annual capital or operating budget, or that exceeds a financial limit; 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 or encumbrance OF ANY REAL PROPERTY; 7. ANY TRANSFER OF ANY PERSONAL PROPERTY OF THE CORPORATION; 8. ANY DISSOLUTION, MERGER, CONSOLIDATION, SALE, OR OTHER CORPORATE restructuring of THE CORPORATION; 9. Any affiliation, joint venture, contract, risk sharing arrangement, employment retention, indemnification, or other arrangements between the Corporation and any insurer, health maintenance organization, or other provider of health or related services, including, without limitation, all service terms and compensation arrangements; 10. ESTABLISHMENT, MODIFICATION, CARRYING ON AND TERMINATION BY THE CORPORATION OF ANY CORPORATE COMPLIANCE PROGRAM; 11. THE GIVING, SEEKING OR RECEIVING AND OVERSIGHT OF ADMINISTRATION Or USE OF GRANTS AND OTHER CONTRIBUTIONS AND GIFTS; 12. 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; 13. THE COMMENCEMENT OR SETTLEMENT OF LITIGATION OR OTHER CLAIMS, OR ALTERNATIVE DISPUTE RESOLUTION, INCLUDING BUT NOT LIMITED TO MEDIATION OR ARBITRATION; 14. ESTABLISHMENT, ADOPTION OR APPROVAL OR AMENDMENT OF FEE SCHEDULES RELATING TO PATIENT SERVICES AND OTHER SERVICES PROVIDED BY THE CORPORATION, ITS EMPLOYEES AND CONTRACTORS; 15. 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; 16. APPROVAL OF ANY STRATEGIC PLAN, BUSINESS PLAN, OR MISSION PLAN OF THE CORPORATION; 17. APPOINTMENT AND REMOVAL THE CORPORATION'S DIRECTORS; 18. DETERMINE, AUTHORIZE AND APPROVE CONTRIBUTIONS TO THE MEMBER OR ANY other organization THAT IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE CODE and DELIVERS OR SUPPORTS THE DELIVERY OF HEALTH CARE SERVICES TO THE PUBLIC; 19. THE FILING OF ANY VOLUNTARY PETITION IN BANKRUPTCY OR ANY OTHER petition OR PLEADING SEEKING ANY REORGANIZATION, receivership or SIMILAR RELIEF UNDER FEDERAL OR STATE LAW; 20. APPROVAL OF THE CREATION AND STRUCTURE of OPERATING UNITS AND appointment of any operating UNIT DIRECTOR(s).
FORM 990, PART VI, section b, line 11B
PROCESS TO REVIEW THE FORM 990: 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.
FORM 990, PART VI, section b, line 12C
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: 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.
FORM 990, PART VI, section b, line 15a & 15B
Process used to determine compensation of management and key employees: 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 line 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.
form 990, part vi, section c, line 19
documents available to the public: 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.
FORM 990, PART VII, SECTION A
COMPENSATION OF OFFICERS AND DIRECTORS: DIRECTORS REPORTED IN PART VII, SECTION A ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS, NOT AS DIRECTORS. Physicians receiving 1099 income from related organization compensation is for administrative and general services rendered for the organization, other professional services and for trauma or other off-hour availability.
FORM 990, PART XI, LINE 9
Other changes in net assets: NET CHANGE IN AFFILIATE TRANSFERS $1,478,168
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.