Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 402,000 | 1,544,933 | 1,161,998 | 1,063,420 | 4,172,351 | |
| 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...... | 27,939,125 | 45,373,306 | 43,739,102 | 46,281,581 | 68,710,618 | 232,043,732 |
| 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. | 27,939,125 | 45,775,306 | 45,284,035 | 47,443,579 | 69,774,038 | 236,216,083 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | 402,000 | 0 | 0 | 0 | 402,000 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 402,000 | 0 | 0 | 0 | 402,000 |
| 8 | Public support (Subtract line 7c from line 6.) | 235,814,083 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 27,939,125 | 45,775,306 | 45,284,035 | 47,443,579 | 69,774,038 | 236,216,083 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 566,300 | 329,739 | 336,387 | 436,579 | 168,771 | 1,837,776 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 566,300 | 329,739 | 336,387 | 436,579 | 168,771 | 1,837,776 |
| 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 VI.) .. | 164,067 | 51,666 | 344,622 | 178,865 | 149,416 | 888,636 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 28,669,492 | 46,156,711 | 45,965,044 | 48,059,023 | 70,092,225 | 238,942,495 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - MISCELLANEOUS INCOME / MEDICAL RECORDS, COLUMN A - 164067.0, COLUMN B - 51666.0, COLUMN C - 344622.0, COLUMN D - 178865.0, COLUMN E - 149416.0, COLUMN F - 888636.0; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part V, Line 1a INDEPENDENT CONTRACTOR REPORTING | COMPENSATION OF INDEPENDENT CONTRACTORS IS PAID BY AND REPORTED ON THE FORM 1096, ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS, OF ASCENSION HEALTH EIN 31-1662309. EXPENSES ARE ALLOCATED TO AND REIMBURSED BY THE FILING ORGANZIATION TO ASCENSION HEALTH. AS SUCH, THE ORGANIZATION HAS NOT REPORTED INDEPENDENT CONTRACTORS PAID ON FORM 990, PART VII, SECTION B |
| Form 990, Part VI, Line 15 CEO COMPENSATION | IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF ST. VINCENT'S AMBULATORY CARE, INC., INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED. IN DETERMINING THE COMPENSATION OF OTHER OFFICERS OF THE ORGANIZATION, THE PROCESS, PERFORMED BY ST. VINCENT'S HEALTH SYSTEM, INC., A RELATED ORGANIZATION WHO PAID THE OTHER OFFICERS, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE AUDIT COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OTHER OFFICERS WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE BOARD MINUTES. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | ST. VINCENT'S AMBULATORY CARE, INC. HAS A SINGLE CORPORATE MEMBER, ST. VINCENT'S HEALTH SYSYTEM, INC |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | ST. VINCENT'S AMBULATORY CARE, INC. HAS A SINGLE CORPORATE MEMBER, ST VINCENT'S HEALTH SYSTEM, INC. WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF ST. VINCENT'S AMBULATORY CARE, INC. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | ALL DECISIONS THAT HAVE A MATERIAL IMPACT TO ST. VINCENT'S AMBULATORY CARE, INC. FINANCIAL INFORMATION OR CORPORATION AS A WHOLE ARE SUBJECT TO APPROVAL BY ITS SOLE CORPORATE MEMBER, ST. VINCENT'S HEALTH SYSTEM, INC. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | MANAGEMENT, INCLUDING CERTAIN OFFICERS, WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. MANAGEMENT PRESENTS THE FORM TO THE BOARD, OR A DESIGNATED COMMITTEE, TO REVIEW. PRIOR TO FILING THE RETURN, ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST ATTESTATION STATEMENT AT THE TIME OF HIRING OR WHEN THEIR SERVICE BEGINS. ANNUALLY, THE CORPORATE RESPONSIBILITY OFFICER SENDS THE CONFLICT OF INTEREST POLICY AND ATTESTATION STATEMENT TO ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES FOR COMPLETION AND RETURN WITHIN TWO WEEKS. THREE SEPARATE MAILINGS ARE SENT OUT WITH TWO WEEK DEADLINES TO RECEIVE A MAXIMUM RESPONSE. THE RESPONSE FROM THE RETURNED ATTESTATION STATEMENT ARE ORGANIZED IN A SPREADSHEET AND ARE CAREFULLY REVIEWED BY THE CORPORATE RESPONSIBILITY OFFICER, THE CHIEF LEGAL OFFICER, AND THE CHIEF EXECUTIVE OFFICER. A FULL REPORT IS PRESENTED TO THE AUDIT COMMITTEE AND ANY POTENTIAL CONFLICTS OF INTEREST ARE HANDLED BY THE COMMITTEE IN AN APPROPRIATE MANNER. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | Incentive Income - Total Revenue: 223424, Related or Exempt Function Revenue: 223424, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Deferred Pension Costs - 63919; Transfer to Sponsor and Other Affiliates - -2596025; |
| FROM 990 PART III COMMUNITY BENEFIT REPORT | This report illustrates the significant degree St. Vincent's Ambulatory Care Inc., ("ACI"), positively contributes to the health status of its' patients and their families in the Northeast Florida and Southeast Georgia communities. ACI is a subsidiary of St. Vincent's HealthCare, a multi-entity health care network that provides essential health services to its community. As a member of Ascension Health, the nation's largest not-for-profit Catholic healthcare system, St. Vincent's HealthCare continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of St. Vincent's HealthCare is to perpetuate the healing mission of the Catholic Church. St. Vincent's HealthCare furthers this goal through delivery of patient services, care to the elderly and indigent, and patient education and health awareness programs for the community. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. In order to fully portray the breadth of our contribution, ACI's community benefit information is described below: Organizational Commitment to Providing Community Benefit: ACI is comprised of three main branches, the Ambulatory Care Specialty practices, the Primary Care practices and the Mobile Health Outreach Ministry (MHOM). ACI contains over 200 physicians specializing in Cardiology, Neurosurgery, Neurology, Infectious Disease, Obstetrics & Gynecology, General Surgery, ENT, Pulmonology/Critical Care, Sleep Medicine and Rheumatology. These providers see patients in 50 different locations, many of them rural markets with limited access to health care. Furthermore, physicians travel 1 to 2 hours to outlying clinics in Georgia daily to serve these patients. Additionally, ACI offers Cardiac Research opportunities providing free medical care to patients who are eligible for study. The Mobile Health Outreach Ministry (MHOM) utilizes five mobile medical clinics that deliver medical care to neighborhoods and communities that lack access to medical care. These fully staffed doctors' offices-on-wheels provide acute and preventive services that include pediatric care, dentistry, and adult medical services. Their unique delivery model is the only one of its kind in the Northeast Florida region that provides free medical care to the area's poor and vulnerable. The MHOM regularly visits middle and high schools located in the lower socioeconomic areas to provide physicals and screenings to children. Additionally, the MHOM vehicles in partnership with local Departments of Health, make scheduled visits to the outlying rural communities to provide primary care and secondary care, to those who lack access to medical care. As a direct result of poor access to care these rural markets experience a higher risk of heart disease high blood pressure, diabetes, and obesity, as well as transforming minor health issues into degenerative more complicated and costly diseases. ACI provides these services to support St. Vincent's HealthCare's mission of service to all persons with special attention to those who are poor and vulnerable. Operations and governance: - St. Vincent's Ambulatory Care has an extensive operations and support team. - ACI recently formed a physician governance council which provides monthly reports to St. Vincent's HealthCare Board of Directors. - ACI is subject to all federal and state regulations including CMS, OBRA and OSHA. - ACI participates in Medicaid Medicare CHAMPUS, Tricare, and/or other government-based health care sponsored health care programs Unreimbursed Services Provided to the Elderly and the Poor: In the spirit of principles adopted by Ascension Health, St. Vincent's ACI has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of ambulatory specialty care to all persons, especially the uninsured and the underserved. During the fiscal year ending June 30, 2015, approximately 57.5% of the values of services rendered were to elderly patients under the Medicare program, and approximately 7.7% of the services were provided to patients under the Medicaid or Charity program. The data below indicates the importance of success to critically needed free medical care provided by St. Vincent's MHOM between July 2013 and June 2014. - More than 25,000 free adult and pediatric patient services were provided, including patient visits health screenings, and case management, as well as outreach services such as delivering food, clothing and critically important medications to the needy. Included among those services are: - Over 4,500 patient visits and case management were completed through our Rural Outreach Ministry. - Over 4,800 patient visits and case management were provided by the Urban Outreach Ministry (Duval, Clay and Nassau counties). - Over 12,000 patient visits and case management were provided through the Pediatric Outreach Ministry, which includes over 3,700 school and sports physicals and approximately 1,200 immunizations. - More than 2,900 nutritional and dietary services that include classes, counseling and fitness training have been provided to children helping to reduce obesity and chronic diseases such as diabetes and heart disease associated. Patient Services: ACI Specialty Practices offer outpatient clinics, surgery, procedures, neurological testing, specialized surgeries aimed to treat cancer patients, sleep studies, radiology, infusions, pulmonary function testing, hearing assessments, obstetric care and deliveries, non invasive cardiac testing and inpatient care. Additionally, ACI offers Cardiac Research, which provides procedures, tests, medications and care to patients at no charge. Cardiology offers specialized programs aimed at reducing hospital re-admissions. The physicians have learned innovative medical procedures, often the first in the country that will extend patients lives or their ability to function in their day to day activities. The MHOM also provides the community with valuable health screenings, education, referrals and medications. If a patient is diagnosed or needs additional screening or follow-up care, the MHOM connects that patient with charity services within St. Vincent's HealthCare or other local non-profits to provide additional specialty services. During the fiscal year ended June 30 2014 ACI provided 194,426 in services. Summary: St. Vincent's Ambulatory Care Inc., furthers its charitable purposes by providing a broad array of medical services with an innovative delivery method to those who are in need of healthcare education and outreach services. ACI provides essential care to the community and offers appropriate charity services to those eligible residents who are unable to pay for their own care. ACI provides care and education to the elderly and infirm that has challenges accessing services in order to improve the overall status of our patients and our community. The care of these people who are so in need of support is the founding mission of the Daughters of Charity. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |