Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 1,238,805 | 435,346 | 1,674,151 |
| 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 | 15,120,477 | 16,691,324 | 18,211,312 | 18,531,990 | 22,983,100 | 91,538,203 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 15,120,477 | 16,691,324 | 18,211,312 | 19,770,795 | 23,418,446 | 93,212,354 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 93,212,354 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 15,120,477 | 16,691,324 | 18,211,312 | 19,770,795 | 23,418,446 | 93,212,354 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | |||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 15,120,477 | 16,691,324 | 18,211,312 | 19,770,795 | 23,418,446 | 93,212,354 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | CLASSES OF MEMBERS OR STOCKHOLDERS: UNITED REGIONAL PHYSICIAN GROUP HAS ONE MEMBER, UNITED REGIONAL HEALTH CARE SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7A | POWER TO ELECT OR APPOINT MEMBERS OF THE GOVERNING BODY: UNITED REGIONAL HEALTH CARE SYSTEM MAY ELECT OR REMOVE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL: THE SOLE MEMBER, UNITED REGIONAL HEALTH CARE SYSTEM, HAS FULL AUTHORITY TO ACT ON THE FOLLOWING MATTERS: 1. DEVELOPMENT, APPROVAL, ADOPTION AND MODIFICATION OF ANNUAL CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; 2. APPROVAL OF ANY FINANCIAL COMMITMENT, OBLIGATION OR EXPENDITURE BY THE CORPORATION OF ANY NON-BUDGETED AMOUNT, OR OF ANY AMOUNT THAT IS IN EXCESS OF AN AMOUNT APPROVED IN AN ANNUAL CAPITAL OR OPERATING BUDGET, OR THAT EXCEEDS A FINANCIAL LIMIT; 3. BORROWING OR LENDING OF MONEY OR THE INCURRENCE OR GUARANTEE OF ANY DEBT OR OTHER FINANCIAL OBLIGATION, DIRECTLY OR INDIRECTLY; 4. CREATION, OWNERSHIP, OR ACQUISITION AND DISSOLUTION OF ANY SUBSIDIARIES OF THE CORPORATION; 5. CREATION, OWNERSHIP, ACQUISITION OF, OR AFFILIATION WITH, ANY OTHER ORGANIZATION AND THE DISSOLUTION OF OR TERMINATION OF AFFILIATION WITH SUCH ORGANIZATION; 6. ANY ACQUISITION, PURCHASE, SALE, LEASE, MORTGAGE, OR OTHER TRANSFER OR ENCUMBRANCE OF ANY REAL PROPERTY; 7. ANY TRANSFER OF ANY PERSONAL PROPERTY OF THE CORPORATION; 8. ANY DISSOLUTION, MERGER, CONSOLIDATION, SALE, OR OTHER CORPORATE RESTRUCTURING OF THE CORPORATION; 9. ANY AFFILIATION, JOINT VENTURE, CONTRACT, RISK SHARING ARRANGEMENT, EMPLOYMENT RETENTION, INDEMNIFICATION, OR OTHER ARRANGEMENTS BETWEEN THE CORPORATION AND ANY INSURER, HEALTH MAINTENANCE ORGANIZATION, OR OTHER PROVIDER OF HEALTH OR RELATED SERVICES, INCLUDING, WITHOUT LIMITATION, ALL SERVICE TERMS AND COMPENSATION ARRANGEMENTS; 10. ESTABLISHMENT, MODIFICATION, CARRYING ON AND TERMINATION BY THE CORPORATION OF ANY CORPORATE COMPLIANCE PROGRAM; 11. THE GIVING, SEEKING OR RECEIVING AND OVERSIGHT OF ADMINISTRATION OR USE OF GRANTS AND OTHER CONTRIBUTIONS AND GIFTS; 12. DEVELOP, ADOPT, APPROVE AND AMEND SALARIES AND OTHER COMPENSATION (INCLUDING THE AWARDING OF ANY INCENTIVE COMPENSATION) AND BENEFITS AND THE OTHER TERMS OF EMPLOYMENT OR ENGAGEMENT OF THE OFFICERS AND EMPLOYEES, INCLUDING PHYSICIAN EMPLOYEES OF THE CORPORATION, AND PHYSICIANS WHO ARE INDEPENDENT CONTRACTORS TO THE CORPORATION; 13. THE COMMENCEMENT OR SETTLEMENT OF LITIGATION OR OTHER CLAIMS, OR ALTERNATIVE DISPUTE RESOLUTION, INCLUDING BUT NOT LIMITED TO MEDIATION OR ARBITRATION; 14. ESTABLISHMENT, ADOPTION OR APPROVAL OR AMENDMENT OF FEE SCHEDULES RELATING TO PATIENT SERVICES AND OTHER SERVICES PROVIDED BY THE CORPORATION, ITS EMPLOYEES AND CONTRACTORS; 15. APPROVAL OF ANY MATERIAL CHANGES IN THE SCOPE OF SERVICES OFFERED BY THE CORPORATION, INCLUDING THE RANGE OF PHYSICIAN SPECIALTIES EMPLOYED BY OR CONTRACTED BY THE CORPORATION; 16. APPROVAL OF ANY STRATEGIC PLAN, BUSINESS PLAN, OR MISSION PLAN OF THE CORPORATION; 17. APPOINTMENT AND REMOVAL OF THE CORPORATION'S DIRECTORS; 18. DETERMINE, AUTHORIZE AND APPROVE CONTRIBUTIONS TO THE MEMBER OR ANY OTHER ORGANIZATION THAT IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE CODE AND DELIVERS OR SUPPORTS THE DELIVERY OF HEALTH CARE SERVICES TO THE PUBLIC; 19. THE FILING OF ANY VOLUNTARY PETITION IN BANKRUPTCY OR ANY OTHER PETITION OR PLEADING SEEKING REORGANIZATION, RECEIVERSHIP OR SIMILAR RELIEF UNDER FEDERAL OR STATE LAW; 20. APPROVAL OF THE CREATION AND STRUCTURE OF OPERATING UNITS AND APPOINTMENT OF ANY OPERATING UNIT DIRECTOR(S). |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE SECRETARY AND THEN BY THE EXECUTIVE COMMITTEE OF UNITED REGIONAL HEALTH CARE SYSTEM, WHICH HAS BEEN DESIGNATED RESPONSIBILITY BY THE BOARD OF DIRECTORS, PRIOR TO FILING OF RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL OFFICERS, DIRECTORS, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED INITIALLY BY THE CHIEF COMPLIANCE OFFICER AND THE CEO FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | PROCESS USED TO DETERMINE COMPENSATION OF MANAGEMENT AND THE OFFICERS: UNITED REGIONAL PHYSICIAN GROUP DOES NOT DETERMINE COMPENSATION FOR THE PRESIDENT/CEO AND OTHER OFFICERS. THEIR COMPENSATION IS DETERMINED AND PAID BY UNITED REGIONAL HEALTH CARE SYSTEM, A RELATED ORGANIZATION. THEREFORE THE ORGANIZATION HAS MARKED LINES 15A AND 15B AS "NO". UNITED REGIONAL HEALTH CARE SYSTEM USES PHYSICIAN COMPENSATION CONSULTANTS AND THE LATEST COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES. COMPENSATION IS ALSO REVIEWED BY THE EXECUTIVE COMMITTEE OF UNITED REGIONAL HEALTH CARE SYSTEM. THE COMPENSATION REVIEW IS CONDUCTED ANNUALLY IN JANUARY BY SULLIVAN COTTER AND IS DOCUMENTED IN THE MEETING MINUTES. |
| FORM 990, PART VII, SECION C, LINE 19 | DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION RUNS AN AD IN THE LOCAL NEWSPAPER ANNUALLY THAT STATES THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VII, SECTION A, LINE 1A | COMPENSATION OF OFFICERS AND DIRECTORS: DIRECTORS REPORTED IN PART VII, SECTION A ARE COMPENSATED FOR THEIR SERVICES AS PHYSICIANS, NOT AS DIRECTORS. Physicians receiving 1099 income from related organization compensation is for administrative and general services rendered for the organization, other professional services and for trauma or other off-hour availability. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS: INTERCOMPANY TRANSFERS $6,956,800 |
| FORM 990, PART VI, SECTION A, LINE 1A | DELEGATION OF AUTHORITY: THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE, CONSISTING OF THE PRESIDENT AND SECRETARY, WHICH HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS BETWEEN SCHEDULED MEETINGS. |
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| Software Version: |