Form990
Click to see attachment
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)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
ST JOSEPH HEALTH SERVICES OF RI
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 HIGH SERVICE AVENUE
Suite
Room/suite
City or town, state or country, and ZIP + 4
NORTH PROVIDENCE, RI02904
D Employer identification number

05-0259026
E Telephone number

G Gross receipts $ 143,815,881
F Name and address of principal officer:
KENNETH BELCHER
200 HIGH SERVICE AVENUE
NORTH PROVIDENCE,RI02904
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SAINTJOSEPHRI.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1946
M State of legal domicile: RI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE MISSION OF ST. JOSEPH HEALTH SERVICES OF RI IS TO PRESERVE, RESTORE AND ENHANCE THE HEALTH OF INDIVIDUALS AND FAMILIES WE SERVE WITHIN OUR COMMUNITIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 8
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 1,602
6 Total number of volunteers (estimate if necessary) ............. 6 35
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 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 283,550 448,375
9 Program service revenue (Part VIII, line 2g) ......... 143,703,182 140,750,185
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 417,051 490,049
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,989,557 2,127,272
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 147,393,340 143,815,881
Expenses; 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) 82,971,703 80,873,097
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 69,107,644 66,736,950
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 152,079,347 147,610,047
19 Revenue less expenses. Subtract line 18 from line 12....... -4,686,007 -3,794,166
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 87,918,744 77,002,711
21 Total liabilities (Part X, line 26)............. 154,113,252 126,904,477
22 Net assets or fund balances. Subtract line 21 from line 20..... -66,194,508 -49,901,766
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
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE MISSION OF ST. JOSEPH HEALTH SERVICES OF RI IS TO PRESERVE,RESTORE AND ENHANCE THE HEALTH OF INDIVIDUALS AND FAMILIES WE SERVE WITHIN OUR COMMUNITIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
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 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 $ 97,127,836 including grants of $   ) (Revenue $ 142,506,534 )
PATIENT HEALTHCARE SERVICES - ST. JOSEPH HEALTH SERVICES OF RI IS DEDICATED TO PROVIDING PATIENT CARE SERVICES, LABORATORY AND TEACHING SERVICES WITHIN THE COMMUNITY. *SEE SCHEDULE O*
4b (Code:   ) (Expenses $ 12,089,802 including grants of $   ) (Revenue $ 0 )
FREE CARE - PER ST. JOSEPH'S PUBLIC NOTICE, ST. JOSEPH HEALTH SERVICES OF RI IS PROUD OF ITS COMMITMENT TO PROVIDE QUALITY CARE TO ALL INDIVIDUALS WHO NEED IT. ST. JOSEPH HEALH SERVICES OF RI PROVIDES FINANCIAL AID TO PATIENTS WITHOUT INSURANCE AND WHO MAY NOT BE ABLE TO PAY FOR THE CARE PROVIDED. *SEE SCHEDULE O*
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet109,217,638
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
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 IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
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............................
5
 
 
6
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 IClick to see attachment........................
6
 
No
7
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 IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; 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 IVClick to see attachment..............
9
 
No
10
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 VClick to see attachment......
10
Yes
 
11
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.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
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 VIIClick to see attachment.......
11b
 
No
c
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 VIIIClick to see attachment.......
11c
 
No
d
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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
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 XClick 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 and XII Click to see attachment.................
12a
 
No
b
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 and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
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, Parts I and IV.........
14b
 
No
15
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 United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
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 United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
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 (see instructions)....
17
 
No
18
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............
18
 
No
19
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...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
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...
21
 
No
22
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........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 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....................... Click to see attachment
23
Yes
 
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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
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
 
 
d
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........ Click to see attachment
25a
 
No
b
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................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
Yes
 
27
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......... Click to see attachment
27
 
No
28
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
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
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 direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
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........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
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... Click to see attachment
35b
Yes
 
36
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.............
36
 
 
37
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 VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
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
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
116
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
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 ..................
2a
1,602
b
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)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
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, securities account, or other financial account)?..........................
4a
 
No
b
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.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
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 as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
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?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
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?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
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
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
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
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
11
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
8
2
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? .................
2
Yes
 
3
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? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
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? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
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.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
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
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
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
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
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?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
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
 
No
b
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
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
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.
19
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.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletKATHLEEN MOORE200 HIGH SERVICE AVENUENORTH PROVIDENCERI02904 (401) 456-3322
Form 990 (2012)
Form 990 (2012)
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. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

RoundBullet 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.

RoundBullet 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KENNETH BELCHER........................................................................
PRESIDENT AND CEO CCHP
 0.0
.......................40.0 		X   X       0 428,652 25,282
(2) JOSEPH SAMARTANO JR DDS........................................................................
TRUSTEE
 1.0
.......................   		X           119,041 0 19,270
(3) ELLEN MCCARTY PHD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(4) JOSEPH P MAZZA MD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(5) LESLIE MARTINEAU........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(6) NANCY ROGERS........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(7) REV PAUL D THEROUX........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(8) REV WILLIAM I VARSANYI........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(9) REVEREND ROBERT FORCIER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(10) ROBERTO ORTIZ MD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(11) STEVEN COLAGIOVANNI MD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(12) MICHAEL CONKLIN JR........................................................................
CFO/TREASURER CCHP
 0.0
.......................40.0 		    X       0 328,671 24,393
(13) KIMBERLY O'CONNELL........................................................................
SENIOR VP
 0.0
.......................40.0 		    X       0 266,785 22,713
(14) PATRICIA NADLE........................................................................
CNO
 40.0
.......................   		      X     250,758 0 19,296
(15) SUSAN CERRONE-ABELY........................................................................
VP CIO
 0.0
.......................40.0 		      X     0 242,888 24,719
(16) DARLEEN SOUZA........................................................................
VP HUMAN RESOURCES
 40.0
.......................   		      X     0 201,342 19,849
(17) DANIEL KANE........................................................................
DENTIST
 40.0
.......................   		        X   295,103 0 18,653
Form 990 (2012)
Form 990 (2012)
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 (list any hours for related organizations below dotted line) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MAUREEN L HARKAVY........................................................................
PHYSICIAN
 40.0
.......................   		        X   310,545 0 13,759
(19) WAJAHAT FAHEEM........................................................................
PHYSICIAN
 40.0
.......................   		        X   338,676 0 28,096
(20) TODD H CARRANZA........................................................................
PHYSICIAN
 40.0
.......................   		        X   342,880 0 9,391
(21) MAGDI L SALMON........................................................................
PHYSICIAN
 40.0
.......................   		        X   236,500 0 9,817
(22) JOHN M FOGARTY........................................................................
FORMER COO
 0.0
.......................   		          X 152,304 0 0
















1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,045,807 1,468,338 235,238
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet43
Yes
No
3
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 ..............
3
Yes
 
4
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...........................
4
Yes
 
5
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 ........
5
 
No
Section B. Independent Contractors
1
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
CLAFLIN CO, PO BOX 7830WARWICKRI028877830 MEDICAL SUPPLIES 2,119,131
SODEXO INC AFFILIATES, PO BOX 360170PITTSBURGHPA15251 FOOD SERVICE 1,175,330
UNIVERSITY PATHOLOGISTS, 300 CENTERVILLE ROAD STE 215WARWICKRI02886 LABORATORY SERVICES 724,200
ASSOCIATES IN ANESTHESIA, 200 HIGH SERVICE AVENUENORTH PROVIDENCERI02904 MEDICAL SERVICES 694,290
MAYO COLLABORATIVE SERVICES INC, PO BOX 9146MINNEAPOLISMN554809146 LABORATORY SERVICES 633,250
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet32
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 61,931
f All other contributions, gifts, grants, and
similar amounts not included above1f 		386,444
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 448,375
Program Service Revenue Business Code
2a NET PATIENT REVENUE 621400 136,516,901 136,516,901    
b OTHER PROGRAM SERVICE REVENUE 541900 3,909,844 3,909,844    
c CAFETERIA 722320 323,440 323,440    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 140,750,185
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 369,346   0 369,346
4 Income from investment of tax-exempt bond proceeds..MediumBullet 75,703     75,703
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 370,923 0
b Less: rental expenses    
c Rental income or (loss) 370,923 0
d Net rental income or (loss).......MediumBullet 370,923     370,923
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 0 45,000
b Less: cost or other basis and sales expenses    
c Gain or (loss) 0 45,000
d Net gain or (loss)..........MediumBullet 45,000     45,000
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a 0
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 0
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 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..MediumBullet 0      
Miscellaneous Revenue Business Code
11a MEANINGFUL USE RECEIPTS 900099 1,642,552 1,642,552 0  
b TRANSFER FROM CCHP FOUNDATION 900099 113,797 113,797    
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 1,756,349
12 Total revenue. See Instructions......MediumBullet 143,815,881 142,506,534 0 860,972
Form 990 (2012)
Form 990 (2012)
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).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 .... 1,577,081   1,577,081  
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 57,620,875 51,446,534 6,174,341  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 855,409 639,590 215,819  
9 Other employee benefits ....... 16,545,082 12,368,086 4,176,996  
10 Payroll taxes ........... 4,274,650 3,196,159 1,078,491  
11 Fees for services (non-employees):        
a Management ...... 10,162,165   10,162,165  
b Legal ......... 1,022,920   1,022,920  
c Accounting ........... 303,554   303,554  
d Lobbying ........... 2,116 2,116    
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 6,995,552 5,359,176 1,636,376  
12 Advertising and promotion .... 78,254   78,254  
13 Office expenses ....... 999,594 355,674 643,920  
14 Information technology ...... 2,000,681 1,635,206 365,475  
15 Royalties .. 0      
16 Occupancy ........... 2,465,453 437,224 2,028,229  
17 Travel ............ 26,272 24,227 2,045  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 42,390 33,744 8,646  
20 Interest ........... 1,045,574 1,045,574    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 5,775,430 4,620,344 1,155,086  
23 Insurance .............. -117,352 -117,352    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 13,990,608 14,108,530 -117,922 0
b BAD DEBT EXPENSE 11,137,334 11,137,334    
c HOSPITAL LICENSING FEE 7,153,847   7,153,847  
d FOOD 727,324 727,324    
e All other expenses 2,925,234 2,198,148 727,086  
25 Total functional expenses. Add lines 1 through 24e 147,610,047 109,217,638 38,392,409 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 655 1 655
2 Savings and temporary cash investments ......... 5,250,579 2 7,364,844
3 Pledges and grants receivable, net ........... 3,225 3 2,675
4 Accounts receivable, net ............. 15,230,073 4 14,745,257
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
177,576 5 266,367
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 178,121 7 129,398
8 Inventories for sale or use .............. 1,535,001 8 1,668,626
9 Prepaid expenses and deferred charges .......... 546,466 9 665,440
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 142,058,837
b Less: accumulated depreciation ..... 10b 110,122,301 35,574,946 10c 31,936,536
11 Investments—publicly traded securities .......... 0 11 0
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 ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 29,422,102 15 20,222,913
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 87,918,744 16 77,002,711
Liabilities 17 Accounts payable and accrued expenses ......... 16,785,654 17 17,494,279
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 677,814 19 6,402
20 Tax-exempt bond liabilities ............. 17,108,210 20 16,531,868
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 1,194,008 23 1,293,510
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
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.................... 118,347,566 25 91,578,418
26 Total liabilities. Add lines 17 through 25......... 154,113,252 26 126,904,477
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. -74,311,981 27 -58,501,685
28 Temporarily restricted net assets ........... 842,349 28 1,101,168
29 Permanently restricted net assets ........... 7,275,124 29 7,498,751
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... -66,194,508 33 -49,901,766
34 Total liabilities and net assets/fund balances ........ 87,918,744 34 77,002,711
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
143,815,881
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
147,610,047
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-3,794,166
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-66,194,508
5
Net unrealized gains (losses) on investments ...............
5
39,880
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
20,047,028
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-49,901,766
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
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?
3a
Yes
 
b
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
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
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
f
g
(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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) right arrow (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.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (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).            
12
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) right arrow (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 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to 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) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
ST JOSEPH HEALTH SERVICES OF RI
  		Employer identification number

05-0259026
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


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
ST JOSEPH HEALTH SERVICES OF RI
  		Employer identification number

05-0259026
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
ST JOSEPH HEALTH SERVICES OF RI
  		Employer identification number

05-0259026
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
2,116
j
Total. Add lines 1c through 1i ...............................
2,116
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING EXPENSE PART II-B, LINE 1I ST. JOSEPH HEALTH SERVICES OF RI PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION OF RHODE ISLAND. THE PORTION OF DUES ALLOCATED TO LOBBYING EFFORTS FOR THE YEAR ENDED 9/30/2013 WAS $2,116.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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.
1a
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 XIII, the text of the footnote to its financial statements that describes these items.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 1,251,348 1,479,931 1,412,982 1,407,395 1,341,680
b Contributions ........ 7,211 10,990 82,754 14,982 45,250
c Net investment earnings, gains, and losses 44,120 138 245 199 29,065
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		704 109,630      
f Administrative expenses ....   130,081 16,050 9,594 8,600
g End of year balance ...... 1,301,975 1,251,348 1,479,931 1,412,982 1,407,395
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet92.000 %
c
Temporarily restricted endowment SchDMd Bullet8.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII 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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   624,770 624,770
b Buildings ................   71,565,443 50,676,327 20,889,116
c Leasehold improvements ............   1,105,332 301,801 803,531
d Equipment ................   68,446,315 59,144,173 9,302,142
e Other .................   316,977 0 316,977
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 31,936,536
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) TRUSTEE UNDER LOAN INDENTURE 2,734,955
(2) BENEFICIAL INTEREST PERP TRUST 6,299,046
(3) TRUSTEE FOR WORKERS COMP/PROF 743,475
(4) ENDOWMENT FUNDS 1,301,400
(5) OTHER ASSETS 2,208,604
(6) MALPRACTICE INSUR. RECEIVABLE 6,225,191
(7) DUE TO/FROM RELATED PARTIES 710,242


Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 20,222,913
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ESTIMATED SETTLEMENTS TO 3RD PARTY 2,987,204
INSURANCE RESERVES 10,529,305
PENSION LIABILITY 73,115,483
ASSET RETIREMENT OBLIGATION 3,527,549
DUE TO/FROM RELATED PARTIES 1,380,669
OTHER LIABILITIES 38,208



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 91,578,418
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
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  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ENDOWMENT FUNDS PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT CONSISTS OF SEVERAL INDIVIDUAL FUNDS ESTABLISHED BY DONORS FOR A VARIETY OF PURPOSES INCLUDING BUT NOT LIMITED TO SCHOLARSHIPS. DISTRIBUTIONS ARE MADE IN ACCORDANCE WITH SPECIFIC DONOR RESTRICTED GUIDELINES.
FIN 48 (ASC 740) FOOTNOTE PART X, LINE 2 ST. JOSEPH HEALTH SERVICES OF RI IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)3 OF THE INTERNAL REVENUE CODE AND IS GENERALLY EXEMPT FROM INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. ST. JOSEPH HEALTH SERVICES OF RI RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. SJSHRI DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITION IN EITHER 2013 OR 2012.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    6,930,527 3,367,948 3,562,579 2.610 %
b Medicaid (from Worksheet 3,
column a) .... 		    20,889,050 17,564,844 3,324,206 2.440 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    27,819,577 20,932,792 6,886,785 5.050 %
Other Benefits
            
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    2,916,216 1,533,736 1,382,480 1.010 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits ..     2,916,216 1,533,736 1,382,480 1.010 %
k Total. Add lines 7d and 7j .     30,735,793 22,466,528 8,269,265 6.060 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,589,106
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,848,244
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
33,293,995
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
41,010,876
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-7,716,881
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 St Joseph Health Services of RI
200 High Service Avenue
North Providence RI,RI02904 		X X         X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
ST JOSEPH HEALTH SERVICES OF RI
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7 Yes  
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17 Yes  
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address Type of Facility (describe)
1 PEDIATRIC DENTAL
21 PEACE STREET
PROVIDENCE,RI02907 		DENTAL
2 ST JOSEPH ADULT PRIMARY CARE CLINIC
21 PEACE STREET
PROVIDENCE,RI02907 		PRIMARY CARE
3 ST JOSEPH OUTPATIENT REHABILITATION
1637 MINERAL SPRING AVENUE
NORTH PROVIDENCE,RI02094 		GENERAL MEDICAL & SURGICAL
4 ST JOSEPH WALK-IN CLINIC
21 PEACE STREET
PROVIDENCE,RI02907 		GENERAL MEDICAL & SURGICAL
5 ST JOSEPH OBGYN CLINIC
21 PEACE STREET
PROVIDENCE,RI02907 		GENERAL MEDICAL & SURGICAL
6 ST JOSEPH PEDIATRIC CLINIC
21 PEACE STREET
PROVIDENCE,RI02907 		GENERAL MEDICAL & SURGICAL
7 ST JOSEPH OUTPATIENT REHABILITATION
21 PEACE STREET
PROVIDENCE,RI02907 		GENERAL MEDICAL & SURGICAL
8 APPLE VALLEY RADIOLOGY & PHLEBOTOMY
466 PUTNAM PIKE
GREENVILLE,RI02828 		RADIOLOGY & PHLEBOTOMY LAB
9 JOHNSTON DENTAL
1524 ATWOOD AVENUE SUITE 125
JOHNSTON,RI02904 		DENTAL
10 PEDIATRIC DENTAL
40 BROAD STREET
PAWTUCKET,RI02860 		DENTAL
11 FATIMA HEALTH CENTER
40 BROAD STREET
PAWTUCKET,RI02860 		HEALTH CENTER
12 WOUND CARE CLINIC
2 WAKE ROBIN
LINCOLN,RI02884 		WOUND CARE CLINIC
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
PERCENT OF TOTAL EXPENSE PART I, LINE 7(F) THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE FOR LINE 7 COLUMN(F) IS $11,137,334. PART I, LINE 7 THE COSTING METHODOLOGY USED TO DERIVE THE AMOUNTS ARE FROM WORKSHEET 2 AND IS BASED ON PATIENT CARE COST TO CHARGES. METHODOLOGY TO DETERMINE BAD DEBT AT COST PART III, LINE 2 THE AMOUNT REPORTED ON PART III LINE 2 IS THE ACTUAL BAD DEBT EXPENSE REPORTED ON THE FINANCIAL STATEMENTS SCALED TO COST. THE COSTING METHODOLOGY IS THE SAME UTILIZED IN PART I, LINE 7. THE HOSPITAL QUALIFIES PATIENTS BASED ON THE MEDICARE PROGRAM 120 DAY RULE WHICH ENTAILS EACH PATIENT ACCOUNT RECEIVING THREE BILLING STATEMENTS. IF NO PAYMENT IS RECEIVED, THE PATIENT ACCOUNT IS PLACED WITH A COLLECTOR 120 DAYS AFTER THE INITIAL STATEMENT IS MAILED. BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FINANCIAL ASSISTANCE POLICY PART III, LINE 3 SJHSRI INTERNALLY TRACKS THE ACCOUNTS TRANSFERRED TO BAD DEBT AND IS ABLE TO DISTINGUISH THE PATIENTS WITH NO INSURANCE COVERAGE. OF THE ACCOUNTS WITH NO COVERAGE, THE BUSINESS OFFICE PROVIDES AN ESTIMATED PERCENTAGE OF THE ACCOUNTS THAT WOULD QUALITY FOR CHARITY IF THEY COMPLETED THE FREE CARE APPLICATION.
BAD DEBT EXPENSE PART III, LINE 4 SJHSRL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THE CHARITY CARE POLICIES WITHOUT CHARGE OR AT AMOUNTS LESS THAN THE ESTABLISHED RATES. BECAUSE SJHSRI DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, SJHSRI ANALYZES ITS PAST HISTORY AND IDENTIFIES ITS REVENUE TRENDS FOR EACH OF ITS MAJOR PAYORS TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE ASSOCIATED PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, SJHSRI ANALYZES CONTRACTUALLY DUE A.'1LOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), SJHSRI RECORDS A SIGNIFICANT ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES, IF APPLICABLE) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SJHSRL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS DECREASED FROM 77.31 % OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30,2012 TO 72.45% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30,2013. SJHSRL'S SELF-PAY WRITEOFFS FOR THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012 AMOUNTED TO $10,475,214 AND $9,297,845, RESPECTIVELY. SJHSRI DID NOT CHANGE ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012, RESPECTIVELY. SJHSRI DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITEOFFS FROM THIRD-PARTY PAYORS IN EITHER 2013 OR 2012.
EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT PART III, LINE 8 NONE OF THE MEDICARE SHORTFALL HAS BEEN TREATED AS A COMMUNITY BENEFIT. THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS IS BASED UPON THE MEDICARE COST REPORT USING RCC (RATIO OF COST CHARGE) METHODOLOGY.
COLLECTION PRACTICES FOR QUALIFIED PATIENTS PART III, LINE 9B ST JOSEPH HEALTH SERVICES OF RI PROVIDES CARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. OUR COLLECTION PROCESS PROVIDES PATIENTS WITH FOUR PROGRESSIVE BILLING NOTICES. ALL STATEMENTS INCLUDE A NOTICE OF AVAILABLE FINANCIAL AID. UNRESOLVED DEBTS ARE TRANSFERRED TO BAD DEBT (WITH NO PAYMENT ACTIVITY) AT DAY 120. AN OUTSIDE COLLECTION AGENCY IS USED FOR ADDITIONAL COLLECTION ACTIVITY. CLIENTS THAT QUALIFY FOR DISCOUNT/FREE-CARE WRITE-OFFS (BASED ON 200-300% OF FEDERAL POVERTY GUIDELINES AND LIMITED ASSETS) HAVE BALANCES REDUCED/WRITTEN-OFF BASED ON INFORMATION DOCUMENTED IN THE APPLICATION PROCESS. ANY BALANCES NOT COVERED BY THE FREE CARE PROCESS ARE BILLED FOLLOWING OUR STANDARD COLLECTION PROCESS.
ST. JOSEPH HEALTH SERVICES OF RI (1) INPUT FROM PERSONS WHO REPRESENT INTERESTS OF THE COMMUNITY PART V, SECTION B, QUESTION 3 ST. JOSEPH HEALTH SERVICES OF RI AND ITS CHNA PARTNERS SOUGHT COMMUNITY INPUT THROUGH INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS, FOCUS GROUPS WITH HEALTHCARE PROVIDERS, AND INCLUSION OF PARTNER HOSPITAL REPRESENTATIVES AS WELL AS PUBLIC HEALTH OFFICIALS IN THE PRIORITIZATION AND IMPLEMENTATION PLANNING PROCESS. CHNA CONDUCTED WITH ONE OR MORE HOSPITAL FACILITIES PART V, SECTION B, QUESTION 4 ST. JOSEPH HEALTH SERVICES OF RI PARTICIPATED IN A STATEWIDE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), LED BY THE HOSPITAL ASSOCIATION OF RHODE ISLAND (HARI), AND ITS MEMBER HOSPITALS: BUTLER HOSPITAL, KENT HOSPITAL, LANDMARK MEDICAL CENTER, MEMORIAL HOSPITAL, OUR LADY OF FATIMA HOSPITAL (ST. JOSEPH'S HEALTH SERVICES OF RI), PROVIDENCE VA MEDICAL CENTER, SOUTH COUNTY HOSPITAL, THE WESTERLY HOSPITAL, AND WOMEN AND INFANTS HOSPITAL. URL FOR CHNA PART V, SECTION B, LINE 5A HTTP://WWW.FATIMAHOSPITAL.COM/FOR-PATIENTS/FATIMA%20CHNA%202013.PDF AMOUNTS BILLED TO INDIVIDUALS WITH NO INSURANCE, PART V, SEC. B, LINE 20D PATIENTS WHO DO NOT HAVE INSURANCE ARE BILLED BASED ON THE HOSPITAL CHARGE MASTER. PATIENTS WHO QUALIFY FOR FULL OR PARTIAL FREE CARE WILL BE DISCOUNTED APPROPRIATELY.
ST. JOSEPH HEALTH SERVICES OF RI (1) GROSS CHARGE FOR SERVICES, PART V, SECTION B, LINE 22 THE HOSPITAL BILLS A LIMITED NUMBER OF PATIENTS WITH ADEQUATE FINANCIAL RESOURCES THE GROSS CHARGE RATE FOR UNINSURED MEDICARE SERVICES.
COMMUNITY HEALTH NEEDS ASSESSMENT PART VI, LINE 2 ST. JOSEPH HEALTH SERVICES OF RI PARTICIPATED IN A STATEWIDE COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), LED BY THE HOSPITAL ASSOCIATION OF RHODE ISLAND (HARI), AND ITS MEMBER HOSPITALS. THE CHNA WAS CONDUCTED FROM SEPTEMBER 2012 TO MAY 2013. THE ASSESSMENT WAS CONDUCTED IN A TIMELINE TO COMPLY WITH REQUIREMENTS SET FORTH IN THE AFFORDABLE CARE ACT, AS WELL AS TO FURTHER THE HOSPITAL'S COMMITMENT TO COMMUNITY HEALTH AND POPULATION HEALTH MANAGEMENT. THE FINDINGS FROM THE ASSESSMENT WILL BE UTILIZED BY OUR LADY OF FATIMA HOSPITAL TO GUIDE ITS COMMUNITY BENEFIT INITIATIVES AND TO ENGAGE PARTNERS TO ADDRESS THE IDENTIFIED HEALTH NEEDS. THE PURPOSE OF THE CHNA WAS TO GATHER INFORMATION ABOUT LOCAL HEALTH NEEDS AND HEALTH BEHAVIORS IN AN EFFORT TO ENSURE HOSPITAL COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND COMMUNITY BENEFIT ACTIVITIES ARE ALIGNED WITH COMMUNITY NEED. THE ASSESSMENT EXAMINED A VARIETY OF COMMUNITY, HOUSEHOLD AND HEALTH STATISTICS TO PORTRAY A FULL PICTURE OF THE HEALTH AND SOCIAL DETERMINANTS OF HEALTH IN THE OUR LADY OF FATIMA HOSPITAL SERVICE AREA. THE FINDINGS FROM THE CHNA WERE UTILIZED BY OUR LADY OF FATIMA HOSPITAL TO PRIORITIZE PUBLIC HEALTH ISSUES AND DEVELOP A COMMUNITY HEALTH IMPLEMENTATION STRATEGY. OUR LADY OF FATIMA HOSPITAL IS COMMITTED TO THE PEOPLE IT SERVES AND THE COMMUNITIES THEY LIVE IN. HEALTHY COMMUNITIES LEAD TO LOWER HEALTH CARE COSTS, ROBUST COMMUNITY PARTNERSHIPS, AND AN OVERALL ENHANCED QUALITY OF LIFE.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 INFORMATION ON THE ST. JOSEPH HEALTH SERVICES OF RI FINANCIAL ASSISTANCE PROGRAM IS COMMUNICATED TO THE PATIENT AT THE POINT OF REGISTRATION THROUGH SIGNAGE WITHIN THE HOSPITAL AND ON THE HOSPITAL'S WEBSITE HTTP://WWW.FATIMAHOSPITAL.COM. FURTHERMORE, THE HOSPITAL HAS PATIENT FINANCIAL COUNSELORS' ONSITE TO EDUCATE PATIENTS ON THE FINANCIAL PROGRAMS THAT ARE AVAILABLE.
COMMUNITY INFORMATION PART VI, LINE 4 St. Joseph Health Services of RI defines its service area as northwest Providence and the surrounding communities of North Providence, Johnston, Cranston, Smithfield, Lincoln and bordering communities to those cities and towns.
PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 IN ADDITION TO ITS ACTIVITIES IN DELIVERING HEALTH CARE SERVICES TO THE COMMUNITY AS DESCRIBED ELSEWHERE IN THIS FILING, ST. JOSEPH HEALTH SERVICES OF RI (SJHSRI) FURTHERS ITS EXEMPT PURPOSES THROUGH THE FOLLOWING MEANS: A) SJHSRI IS MANAGED BY A COMMUNITY BOARD OF TRUSTEES, ON WHICH A SUBSTANTIAL MAJORITY OF TRUSTEES ARE RESIDENTS OF THE HOSPITAL'S EFFECTIVE MARKET AREA AND WHO ARE NEITHER EMPLOYEES OR CONTRACTORS OF THE HOSPITAL. B) WITH THE EXCEPTION OF CERTAIN DEPARTMENTS WHICH, IN THE INTERESTS OF EFFICIENCY, QUALITY AND PROPER ADMINISTRATION, ARE TRADITIONALLY RESERVED TO A SINGLE PHYSICIAN GROUP HAVING AN EXCLUSIVE ARRANGEMENT WITH RESPECT TO THE DEPARTMENT (IE RADIOLOGY, ANESTHESIA, AND PATHOLOGY), SJHSRI MAINTAINS AN OPEN MEDICAL STAFF THAT EXTENDS PRIVILEGES TO ALL QUALIFIED PHYSICIAN APPLICANTS WHO EXHIBIT THE PROPER TRAINING AND EXPERTISE TO SERVE THE HOSPITAL'S PATIENTS. C) THE ORGANIZATION TRADITIONALLY APPLIES ALL SURPLUS FUNDS TO ENSURING FINANCIALLY PRUDENT AVAILABLE FUNDS, CAPITAL MAINTENANCE AND IMPROVEMENTS, AND THE ADDITION OF SERVICES THAT BENEFIT THE COMMUNITY. RWMC AND ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND AFFILIATED IN JANUARY 2010 UNDER CHARTERCARE HEALTH PARTNERS. THE AFFILIATION PARTNERS BELIEVE THAT BY COMBINING THEIR COMPLEMENTARY STRENGTHS, THEY CAN SIGNIFICANTLY IMPROVE THEIR ABILITY TO MEET THE HEALTHCARE NEEDS OF THE REGION THROUGH MORE COORDINATION, IMPROVED EFFICIENCY, REDUCED FRAGMENTATION OF CARE, AND IMPROVED ACCESS FOR THE POOR AND UNDERSERVED PEOPLE IN CHARTERCARE'S EFFECTIVE MARKET AREA AND BEYOND. THE PARTIES RECOGNIZED THAT WHETHER THEY AFFILIATED OR NOT, CHANGE WILL AND MUST OCCUR IN THEIR ORGANIZATIONS IN LIGHT OF EMERGING CHANGES IN HEALTHCARE DELIVERY, AND CHANGES IN PUBLIC AND PRIVATE SYSTEMS FOR PAYING FOR HEALTH CARE. THE AFFILIATION BETTER POSITIONED THE TWO ORGANIZATIONS TO ADDRESS THE CHALLENGES AND TO MEET THE NEEDS OF THEIR COMMUNITIES.
AFFILIATED HEALTH CARE SYSTEM PART VI, LINE 6 ST. JOSEPH HEALTH SERVICES OF RI (SJHSRI) IS PART OF CHARTERCARE HEALTH PARTNERS (CCHP), A COMMUNITY HEALTH SYSTEM THAT SERVES THE CENTRAL AND NORTHWESTERN SEGMENTS OF RHODE ISLAND. THE AFFILIATION OF ROGER WILLIAMS MEDICAL CENTER (RWMC) AND ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND (SJHSRI) IN JANUARY 2010 TO FORM CCHP, ALLOWED BOTH HERITAGE HOSPITALS THE ABILITY TO COMBINE THEIR COMPLEMENTARY STRENGTHS, AND ALLOW THEM TO SIGNIFICANTLY IMPROVE THEIR ABILITY TO MEET THE HEALTHCARE NEEDS OF THE REGION THROUGH MORE COORDINATION, IMPROVED EFFICIENCY, REDUCED FRAGMENTATION OF CARE, AND IMPROVED ACCESS FOR THE POOR AND UNDERSERVED PEOPLE IN CHARTERCARE'S EFFECTIVE MARKET AREA AND BEYOND. SJHSRI'S AFFILIATION ALSO ALLOWS THEM TO WORK CLOSELY WITH RWMC IN THE CREATION OF DEFINED STATE RECOGNIZED CENTERS OF EXCELLENCE IN GERIATRICS, CANCER CARE, GASTROENTEROLOGY AND BEHAVIORAL MEDICINE. THE AFFILIATION OF THE TWO HERITAGE HOSPITALS HAS ALLOWED THEM TO INTEGRATE THE MENTIONED EXISTING SERVICES BETWEEN THE TWO HOSPITALS IN A MANNER THAT BEST SERVES THE EVER EVOLVING COMMUNITIES NEEDS AND IN A MORE INTEGRATED AND MORE EFFICIENT MANNER. IN ADDITION TO SHARING POLICIES AND PROCEDURES FOR BEST OPERATIONAL AND MANAGEMENT PRACTICES, SYSTEM HOSPITALS PARTICIPATE IN A CHARTERCARE QUALITY COMMITTEE. THE CHARTERCARE QUALITY COMMITTEE OVERSEES WORK DONE BY THE HOSPITAL QUALITY COMMITTEES AND HELPS PROMOTE THE WEALTH OF PERFORMANCE IMPROVEMENT AND QUALITY INITIATIVES IN EACH OF THE TWO HOSPITALS (OUR LADY OF FATIMA HOSPITAL AND ROGER WILLIAMS MEDICAL CENTER), ELMHURST EXTENDED CARE (AN EDEN ALTERNATIVE NURSING HOME), ROGER WILLIAMS HOME CARE AND THE SJHSRI CENTER OF HEALTH AND HUMAN SERVICES. THE QUALITIES COMMITTEES THAT OVERSEE CLINICAL PRACTICES WITHIN THE SYSTEM HAVE COMMUNITY REPRESENTATIVES OF THE BOARD OF TRUSTEE AS WELL AS REPRESENTATIVES FROM THE MEDICAL STAFF, NURSING, ADMINISTRATION AND THE QUALITY DEPARTMENTS. STATE FILING OF COMMUNITY BENEFIT REPORT RHODE ISLAND
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)KENNETH BELCHERPRESIDENT AND CEO CCHP (i)
(ii)		 0
401,895 		0
0 		0
26,757 		0
6,406 		0
18,876 		0
453,934 		0
0
(2)MICHAEL CONKLIN JRCFO/TREASURER CCHP (i)
(ii)		 0
328,435 		0
0 		0
236 		0
4,900 		0
19,493 		0
353,064 		0
0
(3)JOHN M FOGARTYFORMER COO (i)
(ii)		 0
0 		0
0 		152,304
0 		0
0 		0
0 		152,304
0 		0
0
(4)DANIEL KANEDENTIST (i)
(ii)		 295,103
0 		0
0 		0
0 		9,093
0 		9,560
0 		313,756
0 		0
0
(5)MAUREEN L HARKAVYPHYSICIAN (i)
(ii)		 310,545
0 		0
0 		0
0 		4,298
0 		9,461
0 		324,304
0 		0
0
(6)WAJAHAT FAHEEMPHYSICIAN (i)
(ii)		 338,676
0 		0
0 		0
0 		7,350
0 		20,746
0 		366,772
0 		0
0
(7)TODD H CARRANZAPHYSICIAN (i)
(ii)		 342,880
0 		0
0 		0
0 		0
0 		9,391
0 		352,271
0 		0
0
(8)MAGDI L SALMONPHYSICIAN (i)
(ii)		 236,500
0 		0
0 		0
0 		0
0 		9,817
0 		246,317
0 		0
0
(9)PATRICIA NADLECNO (i)
(ii)		 248,730
0 		0
0 		2,028
0 		0
0 		19,296
0 		270,054
0 		0
0
(10)SUSAN CERRONE-ABELYVP CIO (i)
(ii)		 0
218,589 		0
0 		0
24,299 		0
5,441 		0
19,278 		0
267,607 		0
0
(11)DARLEEN SOUZAVP HUMAN RESOURCES (i)
(ii)		 0
197,316 		0
0 		0
4,026 		0
5,277 		0
14,572 		0
221,191 		0
0
(12)KIMBERLY O'CONNELLSENIOR VP (i)
(ii)		 0
244,844 		0
0 		0
21,941 		0
5,106 		0
17,607 		0
289,498 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
GROSS-UP PAYMENT AND HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE PART I, LINE 1A PATRICIA NADLE IS A CHARTERCARE HEALTH PARTNERS EMPLOYEE WHO IS THE CNO FOR ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND. SHE BEGAN HER EMPLOYMENT IN OCTOBER 2010 AND RENTS ONE OF THE PROPERTIES OWNED BY THE ST. JOSEPH HEALTH SERVICES OF RI. SHE RECEIVES IN HER PAY CHECK A GROSS-UP IN ORDER FOR HER TO PAY THE RENT FOR THE PROPERTY. IN CALENDAR YEAR 2012, SHE RECEIVED A TOTAL GROSS-UP FOR RENT OF $22,315.
ESTABLISH COMPENSATION PART I, LINE 3 EXECUTIVE SALARIES AND BENEFITS ARE PAID BY CHARTERCARE HEALTH PARTNERS BEGINNING JANUARY 2012. EMPLOYEE SALARIES ARE ESTABLISHED UNDER THE COMPENSATION POLICIES OF THE ORGANIZATION'S MANAGEMENT COMPANY - CHARTERCARE HEALTH PARTNERS.
SEVERANCE PAYMENT PART I, LINE 4A JOHN M FOGARTY RECEIVED A SEVERANCE PAYMENT OF $152,304.
NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATE IN A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED THE FOLLOWING DISTRIBUTIONS UNDER THE 457(F) PLAN: KENNETH BELCHER - $21,809 MICHAEL CONKLIN - $0 KIMBERLY O'CONNELL - $19,388 SUSAN CERRONE-ABELY - $15,329 THE FOLLOWING INDIVIDUALS PARTICIPATE IN A SPLIT DOLLAR LIFE INSURANCE PLAN AND INCLUDED THE FOLLOWING IMPUTED INCOME IN TAXABLE WAGES IN CALENDAR YEAR 2012: KENNETH BELCHER - $4,947 MICHAEL CONKLIN - $236 KIMBERLY O'CONNELL - $129 SUSAN CERRONE-ABELY - $239 DARLEEN SOUZA - $64
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) K BELCHER OFFICER SPLIT DOLLAR PREMIUM   X 19,394 58,181   No Yes   Yes  
(2) S ABELY KEY EMPLOYEE SPLIT DOLLAR PREMIUM   X 6,458 19,373   No Yes   Yes  
(3) K O'CONNELL OFFICER SPLIT DOLLAR PREMIUM   X 3,507 10,520   No Yes   Yes  
(4) M CONKLIN OFFICER SPLIT DOLLAR PREMIUM   X 30,688 92,063   No Yes   Yes  
(5) D SOUZA KEY EMPLOYEE SPLIT DOLLAR PREMIUM   X 8,832 26,495   No Yes   Yes  
(6) P NADLE KEY EMPLOYEE SPLIT DOLLAR PREMIUM   X 19,912 59,735   No Yes   Yes  
Total ......Small Bullet $ 266,367
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
LOANS TO INTERESTED PERSONS PART II CHARTERCARE HEALTH PARTNERS HAS DEVELOPED A COMPENSATION AND BENEFIT PROGRAM TO RETAIN EXPERIENCED HEALTHCARE PROFESSIONALS. UNDER THE PROGRAM CERTAIN EMPLOYEES HAVE BEEN ENROLLED IN A SPLIT DOLLAR LIFE INSURANCE PROGRAM THAT PROVIDES PRE AND POST EMPLOYMENT LIFE INSURANCE BENEFITS. THE LIFE INSURANCE PREMIUMS FOR THIS POLICY HAVE BEEN PAID BY THE HOSPITAL AND IN RETURN THE HOSPITAL HAS RECEIVED A COLLATERAL INTEREST IN THE PROCEEDS OF THE POLICY. UPON THE DEATH OR TERMINATION OF EMPLOYMENT OF THE INSURED, THE HOSPITAL WILL BE REPAID THE AMOUNTS THAT HAVE BEEN ADVANCED. THE AMOUNTS REPORTED AS LOANS REPRESENT THE AGGREGATE PREMIUMS THAT HAVE BEEN PAID TO DATE. INTEREST HAS BEEN COMPUTED ON THESE ADVANCES AND INCLUDED IN TAXABLE COMPENSATION PAID TO EACH EMPLOYEE AS REFLECTED IN FORM W-2.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




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
2012
Open to Public
Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Identifier Return Reference Explanation
ORGANIZATION'S MISSION AND PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART I LINE 1 AND PART III, LINE 4A ST. JOSEPH HOSPITAL WAS ESTABLISHED IN 1892 AS A 175-BED GENERAL HOSPITAL. IT OPERATED AS AN ACUTE CARE HOSPITAL UNTIL 1990, WHEN IT WAS CONVERTED TO A SPECIALTY HOSPITAL THAT HOSTS COMPREHENSIVE PSYCHIATRIC CARE, THE SOUTHERN NEW ENGLAND REHABILITATION CENTER AND THE CENTER FOR HEALTH AND HUMAN SERVICES, AN AWARD-WINNING CLINIC PROVIDING PRIMARY CARE TO THE POOR AND DISADVANTAGED OF SOUTH PROVIDENCE. OUR LADY OF FATIMA HOSPITAL WAS OPENED IN 1954 AS A 175-BED ACUTE CARE HOSPITAL, AND ADDED AN ADDITIONAL 100 BEDS IN 1960. THE HOSPITAL IS A NON-PROFIT, GENERAL ACUTE CARE FACILITY OPERATING UNDER THE SPONSORSHIP OF THE DIOCESE OF PROVIDENCE. TODAY, ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND IS PART OF CHARTERCARE HEALTH PARTNERS (CCHP), A COMMUNITY HEALTH SYSTEM THAT SERVES THE CENTRAL AND NORTHWESTERN SEGMENTS OF RHODE ISLAND. CCHP WAS FORMED IN JANUARY OF 2010 BY THE AFFILIATION OF TWO HOSPITALS: ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND AND ROGER WILLIAMS MEDICAL CENTER. THE INDIVIDUAL HOSPITALS OF CCHP ARE DEEPLY ROOTED IN THEIR COMMUNITIES, EACH WITH A LONG TRADITION OF PROVIDING HIGH QUALITY CARE AND SERVICES. ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND (SJHSRI) OFFERS TREATMENT IN 28 MEDICAL AND SURGICAL SPECIALTIES AND HAS A NATIONALLY RECOGNIZED AMBULATORY CARE CENTER AND ONE OF THE STATE'S BUSIEST SURGICAL PROGRAMS. THE HOSPITAL HAS ACKNOWLEDGED EXCELLENCE IN SEVERAL SURGICAL SUBSPECIALTIES INCLUDING NEUROSURGERY, ORTHOPEDICS, AND UROLOGY. FATIMA ALSO OPERATES THE STATE'S ONLY HOSPITAL-BASED SCHOOL OF NURSING, AND ALSO RUNS SCHOOLS OF MEDICAL TECHNOLOGY, CYTO-TECHNOLOGY AND HISTO-TECHNOLOGY. THE FOLLOWING ARE SELECTED 2013 HIGHLIGHTS FROM SJHSRI: -THIRTY NINE PHYSICIANS AFFILIATED WITH ST. JOSEPH PARENT COMPANY CHARTERCARE HEALTH PARTNERS WERE RECOGNIZED IN RHODE ISLAND MONTHLY AS "TOP DOCTORS" AS VOTED BY THEIR PEERS. -FATIMA HOSPITAL AND ROGER WILLIAMS MEDICAL CENTER OFFICIALLY OPENED THE STATE'S FIRST SENIOR-FRIENDLY EMERGENCY DEPARTMENTS ON MARCH 25. FOR NEARLY A YEAR, BOTH EMERGENCY DEPARTMENTS HAVE UNDERGONE PHYSICAL RENOVATIONS AND MODIFICATIONS, WHILE PROVIDING ENHANCED TRAINING AND ASSESSMENT TOOLS FOR STAFF. -FATIMA HOSPITAL WAS DESIGNATED AS A BLUE DISTINCTION CENTER FOR SPINE SURGERY BY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND FOR DEMONSTRATING BETTER OVERALL QUALITY OF CARE AND PATIENT RESULTS IN THIS SPECIALTY. BLUE DISTINCTION CENTERS FOR SPINE SURGERY HAVE DEMONSTRATED THEIR COMMITMENT TO QUALITY CARE, RESULTING IN BETTER OVERALL OUTCOMES FOR SPINE SURGERY PATIENTS. -FATIMA HOSPITAL WAS ONE OF ONLY 11 HOSPITAL ACROSS THE COUNTRY CHOSEN FOR THE SOCIETY OF HOSPITAL MEDICINE'S 2013-2014 GLYCEMIC CONTROL AND INNOVATIVE CARE COORDINATION PROGRAM. THE PROGRAM'S GOAL IS TO HELP SITES IMPROVE DIABETES CARE PROCESSES, INTERDISCIPLINARY TEAM STRATEGIES, ORDER SETS AND PROTOCOLS AND TRANSITIONS OF CARE. FATIMA IS A JOINT COMMISSION-CERTIFIED SITE FOR ADVANCED DIABETES CARE. COLLABORATION WITH NATIONALLY RECOGNIZED MENTORS PROVIDED BY THE SOCIETY OF HOSPITAL MEDICINE PROGRAM AND THE ACCOMPANYING DATA ANALYSIS WILL ASSIST THE DIABETES TEAM IN ACHIEVING THE GOALS SET FOR CONTINUED JOINT COMMISSION CERTIFICATION, IN ADDITION TO INSURING CONSISTENT, BEST PRACTICE CARE FOR OUR DIABETIC PATIENTS. -THE LABORATORY AT FATIMA HOSPITAL UNDERWENT A SUCCESSFUL INSPECTION BY THE COLLEGE OF AMERICAN PATHOLOGISTS ON JUNE 25. THE ON-SITE LABORATORY INSPECTION WAS CONDUCTED BY A GROUP OF LABORATORY PROFESSIONALS FROM CAPE COD HOSPITAL AND FALMOUTH HOSPITAL. THE ONE DAY INSPECTION IS BASED ON AN EDUCATIONAL PEER REVIEW PROCESS USING NUMEROUS LABORATORY STANDARDS. -ST. JOSEPH SERVICES PARENT COMPANY -- CHARTERCARE HEALTH PARTNERS -- WAS AGAIN RECOGNIZED BY PROVIDENCE BUSINESS NEWS AS ONE OF RHODE ISLAND'S "HEALTHIEST EMPLOYERS." THE HEALTHIEST COMPANIES WERE CHOSEN BASED ON SCORES IN SIX WELLNESS CATEGORIES. -ON DECEMBER 18, PHASE 3 OF THE LABORATORY CONSOLIDATION PROJECT WITH THE IMPLEMENTATION OF "TOTAL LABORATORY AUTOMATION" WAS COMPLETED. THIS COMPLETES THE TRANSITION OF THE CORE LAB IN CHEMISTRY/HEMATOLOGY TO FATIMA. PHASE 3 OF THE CONSOLIDATION INCLUDED WORK FLOW REDESIGN, EQUIPMENT STANDARDIZATION, AND AUTOMATION TO ALLOW FOR IMPROVED QUALITY, A REDUCTION IN TURNAROUND TIMES, AND IMPROVED PRODUCTIVITY. -ONE HUNDRED PERCENT OF THE 2013 GRADUATING CLASS OF THE ST. JOSEPH SCHOOL OF NURSING PASSED THE NATIONAL LICENSURE EXAM (NCLEX-RN.) OUR GRADUATES COLLECTIVELY REGISTERED THE HIGHEST PASS RATE IN THE STATE, OUTPERFORMING THE GRADUATES OF ALL OTHER NURSING PROGRAMS INCLUDING CCRI, URI, RIC, SALVE REGINA, AND NEIT. -THE ST. JOSEPH SCHOOL OF NURSING HELD GRADUATION CEREMONIES FOR ITS 111TH CLASS ON MAY 17 WITH 26 DIPLOMAS AND PINS PRESENTED TO THE GRADUATING CLASS OF 2013. -IN 2013, SIX STUDENTS GRADUATED FROM THE SCHOOL OF MEDICAL TECHNOLOGY AT FATIMA HOSPITAL, COMPLETING A YEAR-LONG LABORATORY INTERNSHIP PROGRAM. THE SCHOOL IS A MEMBER INSTITUTION OF THE BOARD OF RHODE ISLAND SCHOOLS OF ALLIED HEALTH, A CONSORTIUM OF THREE COLLEGE/UNIVERSITY CLINICAL LABORATORY SCIENCE PROGRAMS AND TWO SCHOOLS OF MEDICAL TECHNOLOGY IN THE STATE. FREE CARE PER THE HOSPITAL'S PUBLIC NOTICE, SJHSRI IS PROUD OF ITS COMMITMENT TO PROVIDE QUALITY CARE TO ALL INDIVIDUALS WHO NEED IT. THE HOSPITAL PROVIDES FINANCIAL AID TO PATIENTS WITHOUT INSURANCE AND WHO MAY NOT BE ABLE TO PAY FOR THE CARE PROVIDED. SJHSRI WILL PROVIDE FULL CHARITY CARE TO UNINSURED BASED ON INCOME LIMITS AND FAMILY SIZE. FURTHERMORE, SJHSRI OFFERS PARTIAL CHARITY CARE BASED ON A SLIDING SCALE. THE CENTER FOR HEALTH & HUMAN SERVICES ONE OF THE MOST SIGNIFICANT WAYS IN WHICH SJHSRI GIVES BACK TO THE COMMUNITY IS THROUGH ITS CONTINUED OPERATION OF THE CENTER FOR HEALTH & HUMAN SERVICES, LOCATED IN SOUTH PROVIDENCE. THE CENTER OPERATES A NUMBER OF SERVICES, WHICH MIGHT OTHERWISE BE UNAVAILABLE TO INDIVIDUALS AND FAMILIES IN THE COMMUNITY. THE SERVICES ARE AVAILABLE TO A RANGE OF PEOPLE, FROM INFANTS TO ADULTS. IN 2013, TOTAL HEALTH CENTER VISITS (INCLUDING SATELLITE OFFICES) WERE 25,501.
ORGANIZATION'S MISSION AND PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED) FORM 990, PART I LINE 1 AND PART III, LINE 4A AMONG THE SERVICES OFFERED AT THE CENTER: -PEDIATRIC DENTAL CENTER: THE CENTER OPERATES A HIGHLY SUCCESSFUL PEDIATRIC DENTAL CLINIC SERVICING LOW INCOME AND IMMIGRANT CHILDREN IN PROVIDENCE. THE CENTER HAS EXPANDED BY OPERATING A SATELLITE CENTER IN PAWTUCKET AND JOHNSTON. ALL THREE CENTERS OFFER A FULL RANGE OF PREVENTATIVE AND RESTORATIVE DENTAL SERVICES AND SCHOOL-BASED DENTAL PROGRAMS. THE CENTER HAS RECEIVED NATIONAL RECOGNITION AND ACCLAIM FOR ITS HIGH QUALITY SERVICES. IN 2013, VISITS TO THE PEDIATRIC DENTAL CENTER, INCLUDING SATELLITE OFFICES, TOTALED 44,230. -PEDIATRIC CLINIC: PROVIDES PRIMARY CARE SERVICES FROM BIRTH TO ADOLESCENCE, INCLUDING WELL/SICK VISITS, CHECK-UPS, IMMUNIZATIONS, VISION/HEARING SCREENINGS, HEALTH/NUTRITION EDUCATION AND CHRONIC ILLNESSES LIKE ASTHMA AND DIABETES. MORE THAN 200 EMPLOYEES PARTICIPATED IN PATIENT SAFETY DAY, LEARNING MORE ABOUT A VARIETY OF SAFETY INITIATIVES INCLUDING SAFE MEDICATION PRACTICE, INFECTION CONTROL, AND STROKE RECOGNITION AND RESPONSE. -WOMEN, INFANTS & CHILDREN: PROVIDES HEALTH FOOD & NUTRITION ADVICE TO CHILDREN, PREGNANT WOMEN AND NEW MOTHERS INCLUDING BREASTFEEDING ADVICE AND SUPPORT AS WELL AS REFERRALS TO DOCTORS AND DENTISTS. -LEAD AND IMMUNIZATION CLINICS: PROVIDES LEAD TESTING AND TREATMENT FOR CHILDREN DIAGNOSED WITH LEAD POISONING, AS WELL AS IMMUNIZATIONS TO ANY CHILD (UP TO AGE 19) LIVING IN RHODE ISLAND, REGARDLESS OF INSURANCE STATUS. -ADULT PRIMARY CARE CLINIC: PROVIDES ANNUAL PHYSICALS, SICK VISITS, CARE FOR CHRONIC ILLNESSES, INCLUDING ASTHMA AND DIABETES, IMMUNIZATIONS, AND MEDICAL EDUCATION. -WALK-IN CLINIC: PROVIDES TREATMENT FOR NON-EMERGENT CONDITIONS AND ILLNESSES SUCH AS COMMON COLD SYMPTOMS, INFECTIONS, EARACHES, FEVERS, SCHOOL AND WORK PHYSICALS, AND IMMUNIZATIONS. -SOCIAL SERVICES: PROVIDES MENTAL HEALTH AND PSYCHOSOCIAL ASSESSMENTS, AS WELL AS INDIVIDUAL AND GROUP COUNSELING, CASE MANAGEMENT AND ADVOCACY SERVICES, CRISIS INTERVENTION, PARENTING & HEALTH EDUCATION. -DIABETES RESOURCE CENTER: PROVIDES DIABETES CASE MANAGEMENT, EDUCATION AND PRIMARY CARE REFERRALS FOR ADULTS WITH DIABETES WHO ARE UNINSURED, UNDERINSURED, OR HOMELESS. OPERATES A SATELLITE CENTER IN PAWTUCKET. SERVICE TO THE COMMUNITY SJHSRI HAS A LONG HISTORY AS A LEADER IN SUPPORTING OUR COMMUNITY THROUGH PARTNERSHIPS, EDUCATION, OUTREACH, CHARITY, AND VOLUNTEERISM. THE FOLLOWING IS A BRIEF OVERVIEW OF THE PROGRAMS AND PROJECTS THAT THE STAFF AND VOLUNTEERS WERE INVOLVED WITH IN 2013. 2013 COMMUNITY EDUCATION/HEALTH FAIRS/SCREENINGS -MARCH 7: MORE THAN 200 EMPLOYEES PARTICIPATED IN PATIENT SAFETY DAY, LEARNING MORE ABOUT A VARIETY OF SAFETY INITIATIVES INCLUDING SAFE MEDICATION PRACTICE, INFECTION CONTROL, AND STROKE RECOGNITION AND RESPONSE. -MAY 8: FATIMA HOSPTIAL HOSTED A COMMUNITY HEALTH FAIR FOCUSED ON STROKE SIGNS AND PREVENTION. MORE THAN 200 PEOPLE ATTENDED. -JUNE 19: THE DIABETES OUTREACH TEAM AT FATIMA HOSTED A GUIDED SUPERMARKET TOUR TO INFORM PARTICIPANTS OF BETTER FOOD SHOPPING HABITS WHEN DIAGNOSED WITH DIABETES. 21 PEOPLE PARTICIPATED. -AUGUST 6: FATIMA HOSPITAL AND ROGER WILLIAMS MEDICAL CENTER PARTICIPATED IN THE FIRST-EVER NATIONAL NIGHT OUT, HOSTED BY THE NORTH PROVIDENCE POLICE DEPARTMENT. MORE THAN 500 PEOPLE ATTENDED AND HAD THE OPPORTUNITY TO PARTAKE IN OUR SCREENING/PREVENTION PROJECTS INCLUDING SKIN CANCER SCREENING, SMOKING CESSATION/PREVENTION, DENTAL HYGIENE, AND STROKE CARE. -SEPTEMBER 27: SOUTHERN NEW ENGLAND REHABILITATION CENTER HOSTED A CONFERENCE FOCUSED ON BRAIN INJURY WITH MORE THAN 100 PARTICIPANTS. -MONTH OF OCTOBER: CHARTERCARE HOME HEALTH SERVICES CONDUCTED 30 FLU CLINICS AT VARIOUS ASSISTED LIVINGS : TOTAL 1407 FLU SHOTS GIVEN -OCTOBER 2: 43 MEN WERE SCREENED AT THE ANNUAL PROSTATE CANCER SCREENING. -OCTOBER 7: SOUTHERN NEW ENGLAND REHABILITATION CENTER HELD AN EVENT TO CELEBRATE THE PROGRESS OF REHABILITATION PATIENTS WITH 25 PARTICIPANTS. -OCTOBER 17: FATIMA HOSTED PROGRAM ON PALLIATIVE CARE AND END-OF-LIFE DECISIONS THAT WAS ATTENDED BY 75 PARTICIPANTS. -OCTOBER 19: ST. JOSEPH HEALTH CENTER HOSTED A HEALTH FAIR TO PROVIDE FREE SCREENINGS AND INFORMATION ABOUT A VARIETY OF TOPICS INCLUDING THE SERVICES OFFERED AT THE CENTER'S CLINICS. MORE THAN 200 PEOPLE ATTENDED. -THE WEEK OF OCTOBER 21: FATIMA HOSPITAL HELD A WEEK LONG PROMOTION OF BREAST HEALTH AWARENESS IN THE BREAST CARE CENTER WHICH INCLUDED FREE MAMMOGRAMS, STAFF AVAILABLE TO ANSWER QUESTIONS, AND A VISIT FROM THE GLORIA GEMMA BREAST BUS. -NOVEMBER 2: THE DIABETES EDUCATION TEAM FROM FATIMA HOSPITAL, ALONG WITH DOZENS OF OTHER MEDICAL PROFESSIONALS FROM THE COMMUNITY, DELIVERED SCREENINGS, INFORMATION AND EDUCATIONAL LECTURES RELATED TO DIABETES ON NOVEMBER 2 AT RHODE ISLAND COLLEGE. THIS WAS THE 5TH ANNUAL DIABETES FAIR HOSTED BY FATIMA, A REGIONAL LEADER IN DIABETES CARE. LESS THAN A YEAR AGO, FATIMA BECAME THE FIRST HOSPITAL IN NEW ENGLAND CERTIFIED BY THE JOINT COMMISSION FOR ADVANCED INPATIENT DIABETES CARE. -NOVEMBER 4: OUR LADY OF FATIMA HOSPITAL TEAMED WITH THE AMERICAN CANCER SOCIETY TO HOST A SESSION OF LOOK GOODFEEL BETTER. LGFB IS A HANDS-ON WORKSHOP LEAD BY TRAINED VOLUNTEER COSMETOLOGISTS TO HELP WOMEN UNDERGOING CANCER TREATMENT WITH COSMETICS, SKIN CARE AND HEAD COVERING OPTIONS. -NOVEMBER 23: BONE DAY INCLUDED AN INFORMATIONAL BOOTH WHERE PARTICIPANTS LEARNED ABOUT OSTEOPOROSIS AND THE IMPORTANCE OF STRONG BONES. -DECEMBER 13: MORE THAN 700 CHILDREN GOT IN THE HOLIDAY SPIRIT AT THE 31ST ANNUAL CHRISTMAS PARTY AT THE ST. JOSEPH CENTER FOR HEALTH AND HUMAN SERVICES. THIS EVENT, FOR FAMILIES THAT RECEIVE MEDICAL AND DENTAL CARE AT THE CENTER, INCLUDES GIFTS FROM SANTA, ENTERTAINMENT, CRAFTS AND REFRESHMENTS. COMMUNITY SUPPORT FATIMA HOSPITAL OFFERS SUPPORT GROUPS FOR INDIVIDUALS FACING A VARIETY OF MEDICAL CHALLENGE FROM STROKE TO DIABETES. COMMUNITY PARTNERSHIPS SJHSRI ACTIVELY COLLABORATES WITH SCHOOLS, FELLOW HEALTH CARE PROVIDERS AND OTHERS TO MAXIMIZE OUR CONTRIBUTIONS TO THE COMMUNITY. IN 2013, ST. JOSEPH HEALTH SERVICES ALONG WITH ITS OTHER CCHP-AFFILIATED EMPLOYEES, HELPED RAISE FUNDS FOR A NUMBER OF CHARITABLE CAUSES INCLUDING: -MARTIN LUTHER KING (MLK) DAY: ST. JOSEPH EMPLOYEES VOLUNTEERED AS PART OF OUR MLK DAY EVENT FOR HABITAT FOR HUMANITY, HELPING TO BUILD HOUSES FOR LOW-INCOME FAMILIES IN PAWTUCKET AND PROVIDENCE. -CLOTHING DRIVE: ST. JOSEPH HEALTH SERVICES COLLECTED COATS, MITTENS, AND OTHER GENTLY USED ITEMS FOR THE RHODE ISLAND FURNITURE BANK. -"DAFFODIL DAYS": RAISED MONEY FOR THE AMERICAN CANCER SOCIETY. -THE REHAB RIDERS, A TEAM OF FATIMA EMPLOYEES AND THEIR FRIENDS, AGAIN TOOK PART IN THE MS 150 MILE BIKE RIDE. THE TEAM HAS RAISED OVER $50,000 SINCE ITS FORMATION. -BLOOD DRIVES: ST. JOSEPH'S EMPLOYEES DONATED BLOOD AT QUARTERLY BLOOD DRIVES HELD AT FATIMA HOSPITAL. -SCHOOL OF NURSING RAISED MONEY FOR THANKSGIVING BASKETS FOR THE NEEDY. -SCHOOL OF NURSING RAISED MONEY FOR THANKSGIVING BASKETS FOR THE NEEDY. -SCHOOL OF NURSING RAISED MONEY FOR THANKSGIVING BASKETS FOR THE NEEDY. -CLOTHING DRIVE: ST. JOSEPH HEALTH SERVICES COLLECTED COATS, MITTENS, AND OTHER GENTLY USED ITEMS FOR THE RHODE ISLAND FURNITURE BANK. -"DAFFODIL DAYS": RAISED MONEY FOR THE AMERICAN CANCER SOCIETY. -THE REHAB RIDERS, A TEAM OF FATIMA EMPLOYEES AND THEIR FRIENDS, AGAIN TOOK PART IN THE MS 150 MILE BIKE RIDE. THE TEAM HAS RAISED OVER $50,000 SINCE ITS FORMATION. -BLOOD DRIVES: ST. JOSEPH'S EMPLOYEES DONATED BLOOD AT QUARTERLY BLOOD DRIVES HELD AT FATIMA HOSPITAL. -SCHOOL OF NURSING RAISED MONEY FOR THANKSGIVING BASKETS FOR THE NEEDY.
BUSINESS RELATIONSHIPS PART VI, SECTION A, LINE 2 KENNETH BELCHER AND MICHAEL CONKLIN HAVE A BUSINESS RELATIONSHIP. THEY ARE OFFICERS/DIRECTORS OF ST. JOSEPH HEALTH SERVICES OF RI AND OFFICERS/DIRECTORS OF RELATED FOR PROFIT ENTITIES ROSEBANK CORPORATION, ELMHURST HEALTH ASSOCIATES AND OUR LADY OF FATIMA ANCILLARY SERVICES.
MANAGEMENT FUNCTIONS PART VI, SECTION A, LINE 3 EFFECTIVE JANUARY 4, 2010, THE PRINCIPAL MANAGEMENT FUNCTIONS OF RWMC AND SJHSRI ARE CONDUCTED UNDER THE DIRECTION OF CHARTERCARE HEALTH PARTNER'S OFFICERS, TRUSTEES, AND KEY EMPLOYEES. CONSEQUENTLY, THERE ARE NO KEY EMPLOYEES DISCLOSED FOR THE EXECUTIVE OR FINANCIAL MANAGEMENT FUNCTIONS AFTER JANUARY 2010.
MEMBERS OF THE ORGANIZATION PART VI, SECTION A, LINES 6-7B CHARTERCARE HEALTH PARTNERS IS THE SOLE MEMBER OF ST. JOSEPH HEALTH SERVICES OF RI. CHARTERCARE HEALTH PARTNERS AS THE SOLE MEMBER RESERVES THE POWER TO AMEND THE ARETICLES AND BYLAWS OF THE ENTITY, APPOINT OR REMOVE A MEMBER OF THE BOARD OF TRUSTEES, ENTER INTO CONTRACTS, AND EFFECT ANY DISSOLUTION, ALLILIATION, MERGER, OR REORGANIZATION, AND HAS THE EXCLUSIVE POWER TO APPOINT OR REMOVE THE CEO, CFO AND THE COO (IF ANY).
REVIEW PROCESS PART VI, SECTION B, LINE 11A THE COMPLETION OF THE FORM 990 BEGINS WITH AN OPENING MEETING ATTENDED BY THE CONTROLLER OF CCHP AND KPMG LLP, AN INDEPENDENT TAX CONSULTANT. THE MEETING CONSISTS OF A REVIEW OF THE ORGANIZATIONAL STRUCTURE, SIGNAIFICANT CHANGES IN OPERATIONS OR PROGRAM ACTIVITITES FROM THE PRIOR YEAR, AND OVERVIEW OF CHANGES IN THE FORM 990. THE FINANCE DEPARTMENT GATHERS THE REQUIRED INFORMATION AND POPULATES THE FORM 990 IN CONJUNCTION WITH KPMG LLP. ONCE COMPLETED, THE DRAFT FORM 990 IS REVIEWED WITH SENIOR MANAGEMNT TO ENSURE INDIVIDUALS ARE PROVIDED TIME TO REVIEW AND APPROVE THE FORM 990 PRIOR TO THE DEADLINE. AFTER THE INTERNAL REVIEW IS COMPLETED, THE FORM 990 IS PROVIDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW AND COMMENTS. A MEETING IS HELD TO REVIEW THE FORM 990 AND DISCUSS ANY QUESTIONS AND COMMENTS. UPON FINANCE COMMITTEE APPROVAL, A FINAL COPY OF THE FORM 990 IS DISTRIBUTED TO EACH VOTING BOARD MEMBER AND FILED WITH THE TAXING AUTHORITY.
CONFLICT OF INTEREST PART VI, SECTION B, LINE 12 THE CONFLICT OF INTEREST POLICY INCLUDED IN THE BY-LAWS IS TO PROTECT THE COPRORATION'S INTEREST WHEN IT IS COTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR TRUSTEE OF THE CORPORATION. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND ALL MATERIAL FACTS TO THE OFFICERS, TRUSTEES AND MEMBERS OF ANY COMMITTEES WITH BOARD-DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ON AN ANNUAL BASIS, EACH MEMBER OF THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT AND ALL RESPONSES ARE SUBMITTED AND REVIEWED BY LEGAL COUNSEL. ANY ACTUAL AND POSSIBLE CONFLICTS OF INTEREST ARE REVIEWED WITH THE BOARD OF TRUSTEES.
COMPENSATION POLICY PART VI, SECTION B, LINE 15 EXECUTIVE COMPENATION PHILOSOPHY: THE EXECUTIVE MANAGEMNT MEMBERS OF ST. JOSEPH HEALTH SERVICES OF RHODE ISLAND (SJHSRI) ARE ACCOUNTABLE FOR ENSURING THAT THE MISSION, VISION, AND VALUES ARE CARRIED OUT AT THE HIGHEST LEVELS OF QUALITY, SERVICE AND EFFICIENCY WITHIN THE COMMUNITIES SERVED. THE PROCESS TO DETERMINE ANNUAL EXECUTIVE COMPENSATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE COMMITTEE IS COMPRISED OF INDIVIDUALS WHO ARE INDEPENDENT OF SJHSRI MANAGEMENT, HAVE NO PERSONAL INTEREST IN THE COMPENSATION ARRANGEMENTS, ARE NOT RELATED TO OR UNDER THE CONTROL OF ANY INDIVIDUAL, WHO'S COMPENSATION ARRANGEMENT IS BEING REVIEWED, HAVE NO MATERIAL BUSINESS RELATIONSHIP WITH SJHSRI AND ARE NOT PAID FOR THEIR SERVICES AS BOARD MEMBERS. THE COMMITTEE MAY RETAIN AN INDEPENDENT CONSULTANT TO CONDUCT AN ANNUAL COMPENSATION ANALYSIS AND OR TO PROVIDE ADVISORY SERVICES RELATED TO COMPENSATION. TO ATTRACT AND RETAIN THE HIGHEST CALIBER OF HEATLHCARE PROGESSIONALS NEEDED TO SUSTAIN THE QUALITY OF THE INSTITUTION; COMPENSATION MUST BE COMPETITIVE WITH THAT PROVIDED BY THE ORGANIZATIONS WITH WHICH THE INSTITUTION COMPETES WITHIN THE JOB MARKET. SJHSRI BENCHMARKS EXECUTIVE POSITIONS AGAINST ORGANIZATIONS OF COMPARABLE SIZE AND MISSION ON BOTH A NATIONAL AND REGIONAL LEVEL. COMPENSATION LEVELS REFLECT THE SCOPE OF EACH EXECUTIVE'S RESPONSIBILITIES, EXPERIENCE AND INDUSTRY STANDING AS WELL AS INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. IT IS THE OBLIGATION OF THE COMMITTEE TO ASSESS THE PERFORMANCE OF SJHSRI'S CEO, DETERMINE HIS/HER COMPENSATION AND REPORT IT'S FINDING IN THE REGARD TO THE BOARD. THE COMMITTEE IS ALSO RESPONSIBLE FOR REVIEWING THE PERFORMANCE ASSESSMENTS AND COMPENSATION RECOMMENDATIONS FOR THE EXECUTIVE MANAGEMENT MEMBERS. COMPENSATION DECISIONS ARE MADE IN A MANNER THAT IS CONSISTENT WITH THE EXECUTIVE COMPENSATION GUIDELINES AS PUT FORWARD: EXECUTIVE LEVEL COMPENSATION ADMINSTRATION GUIDELINE: EXECUTIVE PAY SHOULD BE COMMENSURATE WITH THE INDIVIDUAL'S SKILLS, KNOWLEDGE AND EXPERIENCE AS IT RELATES TO THEIR POSITION. THE MINIMUM AND 1ST QUARTILE OF THE COMPETITIVE MARKET COMPOSITE MAY BE APPROPRIATE FOR NEWLY HIRED INDIVIDUALS WITH LIMITED EXPERIENCE IN A COMPARABLE POSITION. FULLY EXPERIENCED INDIVIDUALS WITH A DEMONSTRATED RECORD OF CONSISTENTLY MEETING PERFORMANCE EXPECTATIONS FOR THE POSITION SHOULD GENERALLY BE PAID WITHIN 90% TO 110% OF THE MIDPOINT. HIGHLY EXPERIENCED INDIVIDUALS WITH A DEMOSTRATED RECORD OF CONSISTENLY EXCEEDING PERFORMANCE EXPECTATIONS IN ALL AREAS OF ACCOUNTABILITY, OR AN INDIVIDUAL WITH SPECIAL SKILLS AND EXPERTISE BEYOND THOSE NORMALLY ASSOCIATED WITH THE POSITION TYPICALLY HAVE A PAY TARGET BETWEEN MIDPOINT AND THE 3RD QUARTILE OF THE COMPETITIVE MARKET COMPOSITE. THE MAXIMUM OF THE MARKET COMPOSITE REPRESENTS THE HIGHEST SALARY LEVEL WHICH SJHSRI BELIEVES IS APPROPRIATE FOR THE POSITION. AN INDIVIDUAL WHOSE SALRY IS NEAR THE MAXIMUM OF THE MARKET COMPOSITE WILL BE ELIGIBLE FOR SALARY INCREASE OF NO MORE THAN THE AMOUNT REQUIRED TO REACH THE MAXIMUM MARKET PAY LEVEL.
PUBLIC DISCLOSURE PART VI, LINE 19 ST. JOSEPH HEALTH SERVICES OF RI MAKES ITS TAX RETURN, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE TAX RETURN IS ALSO POSTED ON HTTP://WWW.GUIDESTAR.ORG.
OTHER CHANGES IN NET ASSETS PART XI, LINE 5 ADJUSTMENT TO PENSION LIABILITY $ 19,846,971 CHANGE IN MARKET VALUE OF PERPETUAL TRUSTS $ 200,911 UNRESTRICTED NET ASSET TRANSFER $ (854) -------------- TOTAL $ 20,047,028
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
ST JOSEPH HEALTH SERVICES OF RI
 
Employer identification number

05-0259026
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) CHARTERCARE HEALTH PARTNERS FOUNDATION

200 HIGH SERVICE AVENUE

NORTH PROVIDENCE,RI02908
26-0236669 		FUNDRAISING RI 501(C)(3) 7 CCHP
 
 
No
(2) ROGER WILLIAMS MEDICAL CENTER

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0258959 		HEALTHCARE RI 501(C)(3) 3 CCHP
 
 
No
(3) ROGER WILLIAMS REALTY CORPORATION

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0423855 		RENTAL MGMT RI 501(C)(3) 11 CCHP
 
 
No
(4) RWGH PHYSICIANS OFFICE BUILDING

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
05-0398588 		BLDG MGMT RI 501(C)(3) 11 CCHP
 
 
No
(5) ELMHURST EXTENDED CARE FACILITIES INC

50 MAUDE STREET

PROVIDENCE,RI02908
22-2723407 		NURSING HOME RI 501(C)(3) 3 CCHP
 
 
No
(6) ROGER WILLIAMS MEDICAL ASSOCIATES

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
20-3346936 		PHY PRACTICE RI 501(C)(3) 11 CCHP
 
 
No
(7) CHARTERCARE HEALTH PARNERS

825 CHALKSTONE AVENUE

PROVIDENCE,RI02908
26-4235815 		MANAGEMENT RI 501(C)(3) 11 NA
 
 
No
(8) ST JOSEPH HOSPITAL WORKERS COMP TRUST

200 HIGH SERVICE AVENUE

NORTH PROVIDENCE,RI02904
05-6106574 		TRUST RI 501(C)(3) 11 SJHSRI
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ELMHURST HEALTH ASSOCIATES

825 CHALKSTONE AVENUE
PROVIDENCE,RI02908
05-0437610 		LABORATORY RI CCHP
  		C Corp 0 0     No
(2) OUR LADY OF FATIMA ANCILLARY SERVICES

200 HIGH SERVICE AVENUE
NORTH PROVIDENCE,RI02908
05-0519862 		LABORATORY RI CCHP
  		C Corp 0 0     No
(3) ROSEBANK CORPORATION

825 CHALKSTONE AVENUE
PROVIDENCE,RI02908
05-0342046 		REAL ESTATE RI CCHP
  		C Corp 0 0     No








Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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