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
ST JOSEPHS HOSPITAL HEALTH CENTER
Employer identification number
15-0532254
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:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST JOSEPHS HOSPITAL HEALTH CENTER
Employer identification number
15-0532254
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
THE FOLLOWING INDIVIDUAL RECEIVED COMPENSATION OF MORE THAN $10,000 FROM ST. JOSEPH'S HOSPITAL HEALTH CENTER AND HAVE A FAMILY RELATIONSHIP TO A HOSPITAL BOARD MEMBER: 1. ADAM HOWE, NEPHEW OF KATHRYN RUSCITTO THE FOLLOWING KEY EMPLOYEE HAS A FAMILY RELATIONSHIP WITH A BOARD MEMBER: 1. LOWELL SEIFTER, HUSBAND OF SHARON MCAULLIFE THE FOLLOWING COMPANY RECEIVED COMPENSATION FROM A BUSINESS TRANSACTION OF MORE THAN $100,000 FROM ST. JOSEPH'S HOSPITAL HEALTH CENTER AND A BOARD MEMBER, VINCENT SWEENEY AND HIS FAMILY, OWN THE COMPANY: 1. SYRACUSE OFFICE ENVIRONMENT THE FOLLOWING INTERESTED PERSON(S) HAD A BUSINESS TRANSACTION (COMPENSATION ARRANGEMENT) OF MORE THAN $100,000 FROM ST. JOSEPH'S HOSPITAL HEALTH CENTER AND WERE BOARD MEMBERS, PLEASE SEE PART VII FOR FURTHER DETAIL: 1. KATHRYN RUSCITTO 2. SANDRA SULIK, MD
FORM 990, PART VI, SECTION A, LINE 6
THE MEMBERS OF THE CORPORATION, ST. JOSEPH'S HOSPITAL HEALTH CENTER, INCLUDE AND ARE LIMITED TO THE GENERAL MINISTER AND COUNCIL MEMBERS OF THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS OF THE CORPORATION MAY ELECT THE BOARD OF TRUSTEES AND REMOVE BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBERS OF THE CORPORATION WHO IS THE GENERAL MINISTER AND COUNCIL MEMBERS OF THE SISTERS OF ST. FRANCIS OF THE NEUMANN COMMUNITIES SHALL RETAIN THE POWER AND AUTHORITY TO: - CHANGE THE PHILOSOPHY, MISSION AND PURPOSE OF THE CORPORATION; - ADOPT AND/OR AMEND THE CERTIFICATE OF INCORPORATION; - ADOPT AND/OR AMEND THE BY-LAWS; - ELECT THE BOARD OF TRUSTEES AND REMOVE THE BOARD MEMBERS WITH OR WITHOUT CAUSE; - APPOINT THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION; - APPROVE THE PURCHASE, SALE, LEASE, MORTGAGE OF REAL PROPERTY; AND APPROVE THE PURCHASE, SALE OF GIFT OF CAPITAL ASSETS; - APPROVE THE MERGER, CONSOLIDATION OR AFFILIATION OF THE CORPORATION WITH ANOTHER CORPORATION, ORGANIZATION OR PROGRAM; - APPROVE THE DISSOLUTION OF THE CORPORATION AND DISPOSITION OF ASSETS.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCE COMMITTEE AND THE BOARD OF TRUSTEES WILL REVIEW THE FORM 990 PRIOR TO ITS SUBMISSION. A COPY OF THE 990 WILL BE PROVIDED TO THE COMMITTEE AND BOARD PRIOR TO THE MEETING FOR DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 12C
CONSISTENT WITH THE HOSPITAL BYLAWS WHICH REQUIRES A DUTY TO DISCLOSE, ON AN ANNUAL BASIS AT A DEFINED TIME, ALL BOARD OF TRUSTEES ARE GIVEN THE CONFLICT OF INTEREST POLICY AND FORM TO REVIEW AND COMPLETE. THE PRESIDENT OF THE BOARD OF TRUSTEES TRACKS THE SUBMISSION PROCESS TO ENSURE THAT ALL FORMS ARE COMPLETED AND SUBMITTED. THE INFORMATION FROM THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AT A SUBSEQUENT BOARD MEETING. ANY NEW INDIVIDUALS APPOINTED AS A TRUSTEE WILL COMPLETE THIS REVIEW AND SUBMISSION PROCESS AFTER THEY HAVE BEEN CONFIRMED. THE INTERESTED PERSON IS REQUIRED TO LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF AND VOTE ON THE TRANSACTION OR ARRANGEMENT THAT RESULTS FROM THE CONFLICT OF INTEREST. THE BOARD OF TRUSTEE MEETING MINUTES REFLECT WHENEVER A BOARD MEMBER ABSTAINS FROM VOTING.
FORM 990, PART VI, SECTION B, LINE 15
THE HOSPITAL BYLAWS ESTABLISHES AN EXECUTIVE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, WHICH IS COMPRISED OF INDEPENDENT BOARD MEMBERS DETERMINED TO BE FREE OF ANY CONFLICT OF INTEREST, IS CHARGED WITH DETERMINING EXECUTIVE COMPENSATION AND ESTABLISHING PERFORMANCE CRITERIA ACCORDING TO AN APPROVED COMPENSATION PHILOSOPHY. THE COMMITTEE WORKS WITH AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING AND ADVISORY FIRM, YAFFE & COMPANY, THAT PROVIDES MARKET SURVEY DATA CONCERNING COMPENSATION AND BENEFIT LEVELS FOR FUNCTIONALLY COMPARABLE HEALTHCARE EXECUTIVES IN SIMILAR HOSPITALS ACROSS THE REGION AND THE NATION BASED ON SEVERAL FACTORS INCLUDING SIZE, GEOGRAPHY, HOSPITAL TYPE AND COMPLEXITY. THE COMMITTEE REVIEWS AND APPROVES THE COMPENSATION OF THE SENIOR EXECUTIVES AND ENSURES THAT ALL FORMS OF EXECUTIVE COMPENSATION ARE REASONABLE, APPROPRIATE AND CONSISTENT WITH ITS COMPENSATION PHILOSOPHY. THE COMMITTEE CONTEMPORANEOUSLY DOCUMENTS ITS DECISIONS IN MEETING MINUTES AND REPORTS ITS DECISIONS TO THE FULL BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION C, LINE 19
ST. JOSEPH'S HOSPITAL HEALTH CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. IT DOES HOWEVER PRODUCE AN ANNUAL REPORT WHICH CONTAINS FINANCIAL INFORMATION AND IS READILY DISTRIBUTED AND MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11G
OTHER: PROGRAM SERVICE EXPENSES 54,618,663. MANAGEMENT AND GENERAL EXPENSES 8,599,566. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,218,229.
FORM 990, PART XI, LINE 9:
CHANGE IN NET ASSETS OF ST. JOSEPH'S FOUNDATION 30,498. PENSION & POST RETIREMENT CHANGES 14,196,619. EQUITY TRANSFER -14,361,801. 2012 EQUITY TRANSFER -42,801,971.
PART XII LINE 2C
THERE HAVE BEEN NO CHANGES IN THE OVERSIGHT PROCESS FROM THE PRIOR YEAR.
FORM 990 PART IX LINE 11G
PHYSICIAN CONTRACTS - $19,651,294 MEDICAL PURCHASESD SERVICES 16,378,622 MAINTENANCE CONTRACTS 6,243,702 OTHER PURCHASED SERVICES 5,091,397 CONTRACTED SERVICES 4,777,558 TEMPORARY EMPLOYMENT SERVICES 2,758,943 LAUNDRY AND LINEN 2,625,560 MAINTENANCE AND REPAIR 1,725,470 COLLECTION AGENCY FEES 1,688,127 TRANSCRIPTION SERVICES 1,356,789 OTHER PROFESSIONAL 724,123 RECRUITMENT FEES 145,101 OTHER 51,928
FORM 990, PART B
DURING 2014, THE HEALTH CENTER IDENTIFIED THAT THE ACCOUNTING FOR EMPLOYEE HEALTH REMITTANCES RECEIVED FROM A THIRD-PARTY PAYOR UNDER THE HEALTH CENTER'S SELF-INSURANCE PROGRAM AND OTHER THIRD-PARTY PAYOR ELECTRONIC REMITTANCES WERE NOT PROPERLY REFLECTED IN THE DECEMBER 31, 2013 FINANCIAL STATEMENTS. THIS IS ATTRIBUTED TO A CHANGE IN THE MANNER IN WHICH THIRD-PARTY PAYOR REMITTANCES WERE RECEIVED (FROM PAPER REMITTANCES TO ELECTRONIC REMITTANCES) AND THE UNDERLYING RECOGNITION OF EMPLOYEE HEALTH CLAIMS NOT PROPERLY BEING RETRACTED FROM THE REMITTANCE WHEN ACCOUNTING FOR THE TRANSACTION, THEREFORE OVERSTATING CASH AND CASH EQUIVALENTS, PATIENT ACCOUNTS RECEIVABLE, NET PATIENT SERVICE REVENUE AND TOTAL ASSETS. THE EFFECTS OF THE ADJUSTMENT ON THE DECEMBER 31, 2013 BALANCES ARE PRESENTED BELOW. THE DECEMBER 31, 2013 FINANCIAL STATEMENTS HAVE BEEN RESTATED TO APPROPRIATELY REFLECT THE ACCOUNTING FOR THIRD-PARTY PAYOR EMPLOYEE HEALTH REMITTANCES AND TO PROVIDE COMPARABILITY WITH THE DECEMBER 31, 2014 FINANCIAL STATEMENTS. CASH AND CASH EQUIVALENTS: BALANCE AT DECEMBER 31, 2013, AS PREVIOUSLY STATED: $43,522,898 BALANCE AT DECEMBER 31, 2013, AS RESTATED: $39,548,224 PATIENT ACCOUTNS RECEIVABLE: BALANCE AT DECEMBER 31, 2013, AS PREVIOUSLY STATED: $94,744,185 BALANCE AT DECEMBER 31, 2013, AS RESTATED: $91,635,055 NET PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCE AND DISCOUNTS): BALANCE AT DECEMBER 31, 2013, AS PREVIOUSLY STATED: $551,442,057 BALANCE AT DECEMBER 31, 2013, AS RESTATED: $544,358,253 TOTAL NET ASSETS: BALANCE AT DECEMBER 31, 2013, AS PREVIOUSLY STATED: $234,480,748 BALANCE AT DECEMBER 31, 2013, AS RESTATED: $227,396,944
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.