2012-05-14T14:39:28-05:00 2011-06-30 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2010-07-01 311374523 SOMC MEDICAL CARE FOUNDATION INC SOMC 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 DEAN WRAY 7403567622 2012-05-08 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z MR RANDAL ARNETT 1805 27TH STREET PORTSMOUTH OH 45662 39937647 0 X WWW.SOMC.ORG X 1993 OH SEE SCHEDULE O 11 0 72 0 312295 0 17332770 20193963 19080052 19275348 64189 95613 378127 372295 36855138 39937219 0 0 0 0 29480017 31604510 0 0 0 8155679 9957566 37635696 41562076 -780558 -1624857 6661152 6956591 4175861 6067751 2485291 888840 X SEE SCHEDULE OWE WILL MAKE A DIFFERENCE. AT SOMC, OUR MISSION IS TO MAKE A DIFFERENCE. WE STRIVE TO LIVE OUT THAT MISSION BY PROVIDING OUR REGION WITH THE HIGHEST QUALITY OF CARE, DELIVERED BY PROFESSIONALS WHO ARE AMONG THE BEST IN THEIR FIELDS. WE EXTEND THAT CARE AND PASSION TO MAKE A DIFFERENCE IN THE COMMUNITY BY BEING A VERY GOOD NEIGHBOR, EMPLOYER, AND COMMUNITY SUPPORTER. 0 0 8029512 2548050 SOMC ANESTHESIA ASSOCIATES - MEDICAL DOCTORS TRAINED TO ADMINISTER ANESTHETICS AND MANAGE THE MEDICAL CARE OF PATIENTS BEFORE, DURING, AND AFTER SURGERY. 6105480 1797254 SOMC HEART AND VASCULAR SERVICES - MEDICAL DOCTORS WORKING TO PREVENT, DIAGNOSE, AND TREAT DISORDERS OF THE HEART AND BLOOD VESSELS. 5994757 3575323 SOMC RADIOLOGY SERVICES - MEDICAL DOCTORS TRAINED TO USE STATE-OF-THE-ART RADIANT ENERGY MEDICAL IMAGING TECHNOLOGY TO HELP PREVENT, DIAGNOSE, AND TREAT DISEASES. 21289435 11414721 VARIOUS SPECIALTIES 21289435 11414721 41419184 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 20 0 1 72 1 1 1 0 0 0 0 0 0 0 0 0 X 11 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X RICHARD GILCHER 7403567622 1248 KINNEYS LANE PORTSMOUTH OH 45662 RANDAL ARNETT 1.00 X X 0 681059 300785 CLAUDIA BURCHETT 1.00 X 0 260525 116783 LI-FEN CHANG MD 1.00 X 1005922 0 34571 BENJAMIN GILL 1.00 X 0 124267 26158 VICKI NOEL 1.00 X 0 211813 74955 ELIE SAAB MD 1.00 X 615111 0 92517 LEEANN SAMMONS 1.00 X 0 188092 65533 VINCENT SCARPINATO MD 1.00 X 642410 0 151621 KENDALL L STEWART MD 1.00 X 0 1537137 33645 DEAN WRAY 1.00 X X 0 345786 125933 ELIZABETH SCHMIDT 1.00 X 48840 0 18853 DANIEL B JOVANOVICH 40.00 X 960835 0 204448 HENRY E CHILDERS IV 40.00 X 822826 0 203084 ROBERT J SCHRIMPF 40.00 X 767000 0 37991 SCOTT D LOGAN 40.00 X 745533 0 161199 JENNIFER M JONES 40.00 X 743167 0 22579 6351644 3348679 1670655 56 0 1 0 MEDICAL DOCTOR ASSOCIATES INC 1445 TECHNOLOGY PKWY NW NORCROSS GA 30092 LOCUMS 1235638 ADVANTAGE HEALTHCARE 30 TECHNOLOGY DR SUITE 1N WARREN NJ 07059 ANESTHESIA BILLING 139536 ACCUTYPE MEDICAL SERVICES INC 10300 W 103RD ST OVERLAND PARK KS 66214 DICTATION/TRANSCRIPTION 126674 3 20193963 20193963 PATIENT SERVICES 621300 19275348 19275348 19275348 96041 96041 428 -428 -428 -428 MANAGEMENT SERVICES 561000 170001 170001 BILLING SERVICE FEES 561000 142294 142294 REHAB CARE CREDIT 621110 60000 60000 372295 39937219 19335348 312295 95613 2525787 2525787 25421126 25339259 81867 38649 38401 248 3618948 3593927 25021 1627095 1624965 2130 5387597 5382476 5121 400610 397413 3197 136603 120297 16306 678278 674466 3812 6118 5993 125 9747 9424 323 213676 211625 2051 462908 462908 PHYSICIAN RECRUITMENT 574140 574140 EDUCATION 302343 302331 12 EQUIPMENT RENTAL 46864 46271 593 DUES & LICENSES 26706 26486 220 BOOKS & JOURNALS 24095 23646 449 60786 59369 1417 41562076 41419184 142892 0 1800 2000 1972973 1226114 2393370 2547977 4808 4808 651467 766068 167 2563170 1216287 759257 1346883 877477 1062574 6661152 6956591 3006367 4357171 1169494 1710580 4175861 6067751 X 2485291 888840 2485291 888840 6661152 6956591 X -1624857 28406 X X 0 1 1 X 0 X X X X 0 0 0 SOUTHERN OHIO MEDICAL CENTER 310678022 3 1 1 1 0 1 0 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: SOMC MEDICAL CARE FOUNDATION PROVIDED NONMONETARY SUPPORT TO SOUTHERN OHIO MEDICAL CENTER AS REPORTED IN FORM 990 SCHEDULE R (LEASE OF FACILITIES, PERFORMANCE OF SERVICES, USE OF SHARED EMPLOYEES, AND REIMBURSEMENT OF EXPENSES). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22873 3754 19119 2540297 1212533 1327764 1346883 MALPRACTICE SELF INSURANCE FUND 1062574 1062574 ACCRUED SELF-INSURED LIABILITY 1710580 1710580 0 1 0 0 0 0 0 0 0 RANDAL ARNETT 0 488017 0 165763 0 27279 0 278475 0 22310 0 981844 0 0 CLAUDIA BURCHETT 0 210887 0 48717 0 921 0 92798 0 23985 0 377308 0 0 LI-FEN CHANG MD 989284 0 0 0 16638 0 9800 0 24771 0 1040493 0 0 0 BENJAMIN GILL 0 110672 0 13477 0 118 0 5711 0 20447 0 150425 0 0 VICKI NOEL 0 168156 0 43301 0 356 0 48811 0 26144 0 286768 0 0 ELIE SAAB MD 598521 0 0 0 16590 0 66247 0 26270 0 707628 0 0 0 LEEANN SAMMONS 0 149033 0 38754 0 305 0 41054 0 24479 0 253625 0 0 VINCENT SCARPINATO MD 618191 0 0 0 24219 0 136885 0 14736 0 794031 0 0 0 KENDALL L STEWART MD 0 304212 0 79371 0 1153554 0 14700 0 18945 0 1570782 0 425226 DEAN WRAY 0 257114 0 70500 0 18172 0 106175 0 19758 0 471719 0 0 DANIEL B JOVANOVICH 944197 0 0 0 16638 0 180678 0 23770 0 1165283 0 0 0 HENRY E CHILDERS IV 796837 0 0 0 25989 0 183867 0 19217 0 1025910 0 0 0 ROBERT J SCHRIMPF 750242 0 0 0 16758 0 18350 0 19641 0 804991 0 0 0 SCOTT D LOGAN 728973 0 0 0 16560 0 134829 0 26370 0 906732 0 0 0 JENNIFER M JONES 672028 0 0 0 71139 0 7913 0 14666 0 765746 0 0 0 PART I, LINE 4B SOUTHERN OHIO MEDICAL CENTER, A RELATED ORGANIZATION, MADE CONTRIBUTIONS TO A SERP FOR THE FOLLOWING INDIVIDUALS: RANDAL ARNETT: $261,325 DEAN WRAY: 91,475 CLAUDIA BURCHETT: 71,795 VICKI NOEL: 35,834 LEEANN SAMMONS: 31,512 THE SERP PLAN IS AVAILABLE ONLY TO INDIVIDUALS WHO HAVE HELD AN EXECUTIVE POSITION FOR ONE YEAR. THE SERP WILL VEST UPON THE EXECUTIVE REACHING A SPECIFIED AGE. IF AN EXECUTIVE SEVERS EMPLOYMENT OR IS TERMINATED, A NONCOMPETE AGREEMENT IS IN PLACE FOR 2 YEARS. THE EXECUTIVE FORFEITS ANY SERP PAYMENTS IF HE/SHE DOES NOT CONFORM TO THE NONCOMPETE AGREEMENT. SOUTHERN OHIO MEDICAL CENTER, A RELATED ORGANIZATION, MADE CONTRIBUTIONS TO A CERP (COMMUNITY EMERGENCY RESPONSE PLAN) FOR THE FOLLOWING INDIVIDUALS: DR. HENRY CHILDERS: 28,800 DR. DANIEL JOVANOVICH: 21,075 DR. ROBERT SCHRIMPF: 8,550 DR. SCOTT LOGAN: 1,450 DR. VINCENT SCARPINATO: 17,900 DR. ELLIE SABB: 4,875 THE CERP PROGRAM IS AN INCENTIVE PROGRAM FOR PHYSICIANS TO BE AVAILABLE ON CALL IN THE EVENT OF AN EMERGENCY. A PHYSICIAN MUST PARTICIPATE IN THE PROGRAM FOR 5 YEARS BEFORE BECOMING VESTED AND THE PHYSICIAN ALSO MUST REACH A SPECIFIED AGE. A NONCOMPETE AGREEMENT IS IN PLACE, AND THE PHYSICIAN FORFEITS ANY CERP PAYMENTS IF HE/SHE DOES NOT CONFORM TO THE NONCOMPETE AGREEMENT. THE AMOUNTS LISTED ABOVE ARE INCLUDED IN COMPENSATION REPORTED IN SCHEDULE J, PART II, COLUMN C. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEYS, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. DR HENRY CHILDERS EDUCATIONAL LOAN X 25000 4808 0 1 1 4808 FORM 990, PART VI, SECTION A, LINE 6 SOMC MEDICAL CARE FOUNDATION HAS A SINGLE SHARE OF STOCK OWNED BY DR. KENDALL STEWART, PRESIDENT & CEO. THE ORGANIZATION WAS REQUIRED TO HAVE A SHAREHOLDER UPON ITS FORMATION, IN ORDER TO QUALIFY AS A PROFESSIONAL ASSOCIATION. DR. STEWART REPRESENTS THE TRUSTEE WHO HOLDS LEGAL TITLE TO THE SHARE BUT THE BENEFICIAL OWNER OF THE SHARE, AND THE SOLE VOTING MEMBER, IS SOUTHERN OHIO MEDICAL CENTER. DR. STEWART HAS SIGNED AN AGREEMENT STATING HE HOLDS THE SHARE ONLY BECAUSE A PHYSICIAN IS REQUIRED TO, AND THAT ALL DUTIES REST WITH SOUTHERN OHIO MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A SOMC MEDICAL CARE FOUNDATION'S BOARD OF DIRECTORS ARE ELECTED BY SOUTHERN OHIO MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B SOMC MEDICAL CARE FOUNDATION'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY SOUTHERN OHIO MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 INFORMATION IS COMPILED IN THE ACCOUNTING DEPARTMENT THEN SENT TO THE INDEPENDENT TAX ACCOUNTANTS TO ANALYZE THE INFORMATION AND COMPLETE THE TAX RETURN. THE FORM IS THEN REVIEWED BY FINANCIAL STAFF, TIED OUT TO THE TRIAL BALANCE, AND E-MAILED TO THE BOARD. IN ADDITION, THE CFO PRESENTS FORM 990 TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE FILLED OUT ANNUALLY IN JANUARY FOR OFFICERS AND FOR NEW AND RETURNING BOARD MEMBERS. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE. ANY CONFLICTS ARE DOCUMENTED IN THE MINUTES AND ADDRESSED. CONFLICTS OF INTEREST ARE RAISED BY OFFICERS OR BOARD MEMBERS ONCE THEY ARE KNOWN BY THE INDIVIDUAL. BOARD MEMBERS ABSTAIN FROM VOTING IF A CONFLICT IS IDENTIFIED THAT THE BOARD MEMBER IS INVOLVED WITH. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW IS COMPLETED BY A RELATED ORGANIZATION, SOUTHERN OHIO MEDICAL CENTER. ON AN ANNUAL BASIS, AN INDEPENDENT CONSULTANT PROVIDES THE BOARD COMPENSATION COMMITTEE WITH COMPARABLE DATA AND OTHER FACTS WHICH ARE USED BY THE COMMITTEE TO DETERMINE EXECUTIVE PAY PHILOSOPHY. THE DECISIONS FOR OFFICER COMPENSATION ARE DOCUMENTED IN THE BOARD COMPENSATION COMMITTEE MINUTES, WHICH WAS LAST PERFORMED DURING 2011. THIS COMMITTEE DETERMINES THE CEO'S PAY AND SETS PAY RANGES FOR THE OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023, FORM 990, AND FORM 990-T ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 SOMC MEDICAL CARE FOUNDATION, INC. PROVIDES ITS FINANCIAL STATEMENTS TO THE PUBLIC THROUGH ITS BOND DISCLOSURE. GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC ON SOUTHERN OHIO MEDICAL CENTER'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 28,406. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 1, PART I, LINE 1: SOMC MEDICAL CARE FOUNDATION IS ORGANIZED AND OPERATES EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR ANY SUCCESSOR STATUTE BY RENDERING ANY TYPE OF PROFESSIONAL SERVICE IN THE PRACTICE OF MEDICINE OR SURGERY OR ANY OF ITS BRANCHES, AUTHORIZED UNDER CHAPTER 4731 OF THE OHIO REVISED CODE, FOR THE BENEFIT OF SOMC, AN OHIO NON-PROFIT CORPORATION INCLUDING (A) PROVIDING MEDICAL,SURGICAL AND OTHER HEALTH CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED, REGARDLESS OF RACE, COLOR, RELIGION, NATIONAL ORIGIN, AGE, HANDICAP, SEX, OR THE ABILITY TO PAY FOR SERVICES; (B) CONDUCTING EDUCATIONAL ACTIVITIES RELATED TO HEALTHCARE AND TREATMENT OF THE SICK, DISABLED, INJURED AND TO PROMOTE AND CARRY ON MEDICAL, SCIENTIFIC AND CLINICAL RESEARCH RELATED TO HEALTH CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED; AND (C) ENGAGING IN ANY LAWFUL ACTIVITIES FOR WHICH CORPORATIONS MAY BE FORMED UNDER CHAPTER 1785 OF THE OHIO REVISED CODE THAT ARE NOT CONSISTENT WITH THE FOREGOING. FORM 990, PART VII: THE FOLLOWING OFFICERS DEVOTED TIME TO SOUTHERN OHIO MEDICAL CENTER: RANDAL ARNETT 40 HOURS DEAN WRAY 40 HOURS KENDALL STEWART 40 HOURS CLAUDIA BURCHETT 40 HOURS VICKI NOEL 40 HOURS LEANN SAMMONS 40 HOURS BENJAMIN GILL 40 HOURS SOUTHERN OHIO MEDICAL CENTER 1248 KINNEYS LANE PORTSMOUTH OH 45662 310678022 HEALTH CARE OH 501(C)(3) 3 N/A 0 SOMC FOUNDATION INC 1805 27TH STREET PORTSMOUTH OH 45662 311564440 HOLD INVESTMENTS FOR BENEFIT OF SOUTHERN OHIO MEDICAL CENTER OH 501(C)(3) LINE 11A, I SOUTHERN OHIO MEDICAL CENTER 1 SOUTHERN OHIO MEDICAL CENTER TITLE HOLDING COMPANY 1805 27TH STREET PORTSMOUTH OH 45662 311417566 MANAGE REAL ESTATE OH 501(C)(2) N/A SOUTHERN OHIO MEDICAL CENTER 1 THE FRIENDS OF SOUTHERN OHIO MEDICAL CENTER 1805 27TH STREET PORTSMOUTH OH 45662 310677520 FUNDRAISING OH 501(C)(3) LINE 11A, I SOUTHERN OHIO MEDICAL CENTER 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 SOUTHERN OHIO MEDICAL CENTER C 19574646 ACCRUAL TRANSACTIONS SOUTHERN OHIO MEDICAL CENTER I 238639 RENTAL CHARGES PER CONTRACT SOUTHERN OHIO MEDICAL CENTER K 142581 COST PER CONTRACT SOUTHERN OHIO MEDICAL CENTER L 52369 COST PER CONTRACT SOUTHERN OHIO MEDICAL CENTER N 29118611 ALLOCATION OF COSTS SOUTHERN OHIO MEDICAL CENTER O 8293102 ALLOCATION OF COSTS SOUTHERN OHIO MEDICAL CENTER P 16421024 ALLOCATION OF COSTS SOMC TITLE HOLDING COMPANY J 619317 RENTAL CHARGES PER CONTRACT SOMC TITLE HOLDING COMPANY C 619317 FORGIVENESS OF RENTAL CHARGES