Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JEWISH HOSPITAL & ST MARY'S HEALTHCARE INC
Employer identification number
61-1029768
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
13000248
Software Version:
2013v3.1
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
JEWISH HOSPITAL & ST MARY'S HEALTHCARE INC
Employer identification number
61-1029768
Return Reference
Explanation
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE SOLE CORPORATE MEMBER OF JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. IS KENTUCKYONE HEALTH, INC.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
CERTAIN RIGHTS MAY BE RESERVED BY THE CORPORATE MEMBER IN ACCORDANCE WITH THE BYLAWS AND THE LAWS OF THE COMMONWEALTH OF KENTUCKY. THE BUSINESS, PROPERTY, AFFAIRS AND FUNDS OF THE CORPORATION SHALL BE MANAGED, SUPERVISED, AND CONTROLLED BY THE BOARD OF DIRECTORS, IN CORFORMITY WITH APPLICABLE POLICIES, PROCEDURES, AND THE MISSION OF THE CORPORATION AND THE CORPORATE MEMBER.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE VP OF FINANCE AND AN ELECTRONIC COPY IS PROVIDED TO EACH MEMBER OF THE BOARD. AFTER THE RETURN IS REVIEWED BY THE VP OF FINANCE, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NONSUBSTANTIVE CHANGES NECESSARY THAT EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RESUBMITTED TO THE BOARD. SUBSEQUENT TO THE RETURN BEING FILED, THE PRESIDENT/CEO OF KENTUCKYONE HEALTH, INC., THE SOLE MEMBER OF THE ORGANIZATION, PRESENTS THE RETURN AT A JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. BOARD MEETING.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
ANNUAL STATEMENTS ------------------- EACH TRUSTEE, DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS OF JHSMH, INC, SHALL ANNUALLY SIGN A STATEMENT, WHICH AFFIRMS THAT SUCH PERSON: -HAS RECEIVED A COPY OF JHSMH'S CONFLICTS OF INTEREST POLICY, -HAS READ AND UNDERSTANDS THIS POLICY, -HAS AGREED TO COMPLY WITH THIS POLICY, AND -UNDERSTANDS THAT THE JHSMH EXEMPT ENTITIES ARE CHARITABLE ORGANIZATIONS AND THAT IN ORDER TO MAINTAIN THEIR FEDERAL TAX EXEMPTIONS THEY MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF THEIR TAX-EXEMPT PURPOSES. ANNUAL QUESTIONNAIRE -------------------- EACH TRUSTEE, DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS OF JHSMH, INC. AND KEY EMPLOYEE OF JHSMH, SHALL ANNUALLY COMPLETE A CONFLICTS OF INTEREST QUESTIONNAIRE. COMPLETION OF THE ANNUAL QUESTIONNAIRE IS COORDINATED BY GENERAL COUNSEL AND JHSMH'S CORPORATE COMPLIANCE OFFICER. PERIODIC REVIEWS -------------------- TO ENSURE THAT EACH OF THE JHSMH EXEMPT ENTITIES OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING SUBJECTS: -WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE AND ARE THE RESULT OF ARM'S-LENGTH BARGAINING. -WHETHER ACQUISITIONS OF PHYSICIAN PRACTICES AND OTHER PROVIDER SERVICES RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. -WHETHER PARTNERSHIP AND JOINT VENTURE ARRANGEMENTS AND ARRANGEMENTS WITH MANAGEMENT SERVICE ORGANIZATIONS AND PHYSICIAN HOSPITAL ORGANIZATIONS CONFORM TO WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE PAYMENTS FOR GOODS AND SERVICES, FURTHER SUCH JHSMH EXEMPT ENTITY'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. -WHETHER AGREEMENTS TO PROVIDE HEALTH CARE AND AGREEMENTS WITH OTHER HEALTH CARE PROVIDERS, EMPLOYEES, AND THIRD PARTY PAYORS FURTHER SUCH JHSMH EXEMPT ENTITY'S CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT OR IMPERMISSIBLE PRIVATE BENEFIT. IN CONDUCTING SUCH PERIODIC REVIEWS, A JHSMH EXEMPT ENTITY MAY, BUT NEED NOT, USE OUTSIDE ADVISORS. IF OUTSIDE EXPERTS ARE USED, THEIR USE SHALL NOT RELIEVE THE GOVERNING BOARD OF ITS RESPONSIBILITY FOR ENSURING THAT PERIODIC REVIEWS ARE CONDUCTED.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees
THE FOLLOWING REVIEW AND APPROVAL PROCESS IS USED BY JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. (JHSMH) FOR MOST DISQUALIFIED PERSONS, WHICH INCLUDES ALL OFFICERS AND KEY EMPLOYEES. THE MANAGEMENT REVIEW COMMITTEE IS RESPONSIBLE FOR REVIEW AND APPROVAL OF MANAGEMENT COMPENSATION. THE FULL COMMITTEE ADDRESSED THE OVERALL COMPENSATION PHILOSOPHY AND HOW THE ORGANIZATION'S GOALS CAN BE FURTHERED BY THE STRUCTURE OF COMPENSATION. THE INDEPENDENT MANAGEMENT REVIEW COMMITTEE AND ALL INDEPENDENT MEMBERS OF THE FULL BOARD APPROVED MAXIMUM COMPENSATION LEVELS FOR ALL DISQUALIFIED PERSONS. NON-INDEPENDENT DIRECTORS DID NOT PARTICIPATE IN THE DISCUSSION OR VOTE ON COMPENSATION LEVELS FOR INDIVIDUALS. THE MANAGEMENT REVIEW COMMITTEE RETAINED AN OUTSIDE COMPENSATION CONSULTANT FROM A NATIONAL FIRM TO ADVISE IT REGARDING REASONABLE COMPENSATION LEVELS, AND RELIED ON THE CONSULTANT'S OPINION THAT COMPENSATION LEVELS ARE REASONABLE. THE COMMITTEE RECEIVES A MARKET REVIEW ON EACH DISQUALIFIED PERSON FROM THE COMPENSATION CONSULTANT. THE MANAGEMENT REVIEW COMMITTEE APPROVED THE PEER GROUP OF SIMILAR ENTITLES USED TO MEASURE COMPARABLE COMPENSATION LEVELS. THE MANAGEMENT REVIEW COMMITTEE FOLLOWS THE PROCESS NECESSARY TO OBTAIN THE REBUTTABLE PRESUMPTION THAT COMPENSATION LEVELS ARE REASONABLE, INCLUDING CONTEMPORANEOUS DOCUMENTATION OF DECISIONS.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
JEWISH HOSPITAL & ST. MARY'S HEALTHCARE, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC.
Form 990, Part IX, Line 11g, Other Expenses
PHYSICIAN SERVICES - TOTAL EXPENSE: 12075448, PROGRAM SERVICE EXPENSE: 12075448, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CLINICAL ENGINEERING - TOTAL EXPENSE: 10588100, PROGRAM SERVICE EXPENSE: 10588100, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; FOOD SERVICES - TOTAL EXPENSE: 7036284, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 7036284, FUNDRAISING EXPENSES: ; LABORATORY - TOTAL EXPENSE: 1907392, PROGRAM SERVICE EXPENSE: 1907392, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; OTHER CONTRACTED SERVICES - TOTAL EXPENSE: 97982040, PROGRAM SERVICE EXPENSE: 66644660, MANAGEMENT AND GENERAL EXPENSES: 31064693, FUNDRAISING EXPENSES: 272687;
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances
PENSION ADJUSTMENT - -4760000; CHANGE IN NONCONTROLLING INTEREST - -1509433; OTHER CHANGES IN NET ASSETS - -633611; PRIOR PERIOD ADJUSTMENT VNA - -1104297;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.