2016-11-21T12:57:48-06:00 2015-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2015-01-01 273899821 ST JOSEPH'S MEDICAL PC STJO 3157032106 301 PROSPECT AVENUE SYRACUSE NY 13203 SANDRA M SULIK PRESIDENT 3157032106 2016-11-21 1 ANGELA M FRANCO P00589741 3154463600 2015 2017-02-10 21:41:12Z SANDRA M SULIK 301 PROSPECT AVENUE SYRACUSE NY 13203 38202805 0 X WWW.SJPHYSICIANS.ORG X 2010 NY TO PROVIDE PRIMARY AND SPECIALTY PROFESSIONAL MEDICAL SERVICES TO THE COMMUNITY. 1 0 606 0 1459 459 0 0 29706959 31494298 925882 22073 3097396 6595477 33730237 38111848 0 0 0 0 32014283 34303669 0 0 0 13934959 14531719 45949242 48835388 -12219005 -10723540 36622010 12565008 27247170 25335099 9374840 -12770091 X TO PROVIDE PRIMARY AND SPECIALTY PROFESSIONAL MEDICAL SERVICES TO THE COMMUNITY 1 0 29816345 22075507 FAMILY & INTERNAL MEDICINE - ST. JOSEPH'S MEDICAL PC HAS 5 FAMILY PRACTICES AND 1 INTERNIST PRACTICE COVERING THE CNY AREA. THERE ARE 7 OFFICES LOCATED IN LIVERPOOL IN THE NORTH MEDICAL BUILDING, 5 OFFICES LOCATED IN FAYETTEVILLE IN THE NORTHEAST MEDICAL BUILDING, 1 OFFICE IN BALDWINSVILLE, 1 OFFICE IN CAZENOVIA AND 1 OFFICE IN SYRACUSE IN THE ST. JOSEPH'S MOC BUILDING. THE PRACTICES HAD A TOTAL OF 169,744 VISITS IN 2015. 8446366 5888044 URGENT CARE - THE MEDICAL PC HAS 2 URGENT CARE LOCATIONS, 1 IN THE LIVERPOOL NORTH MEDICAL BUILDING AND 1 IN THE FAYETTEVILLE NORTHEAST MEDICAL BUILDING. THE URGENT CARE SERVES THE COMMUNITY WITH 7 DAYS PER WEEK AS AN EXTENSION OF OUR PHYSICIAN PRACTICES AND HOSPITAL TREATING MINOR INJURIES TO MORE ACUTE COMPLEX ILLNESS. THE URGENT CARE HAD 61,788 VISITS IN 2015. 7592569 5261954 SURGICAL SERVICES, INCLUDING GENERAL AND THORACIC - THE MEDICAL PC HAS A TEAM OF SURGEONS THAT OFFER COMPREHENSIVE SURGICAL CARE FOR AMBULATORY, ELECTIVE AND CRITICALLY ILL PATIENTS. THE SURGICAL SERVICES PROVIDE BOTH INPATIENT AND OUTPATIENT PROCEDURES. THEY HAVE 2 OUTPATIENT OFFICES, 1 LOCATED IN LIVERPOOL AT NORTH MEDICAL AND THE OTHER IN FAYETTEVILLE AT THE NORTHEAST MEDICAL BUILDING. THE SURGEONS HAD 20,569 OFFICE VISITS IN 2015. 2734816 4862811 OTHER PROGRAM SERVICES 2734816 4862811 48590096 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 81 0 1 606 1 1 1 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X MEREDITH PRICE 3154485888 301 PROSPECT AVE SYRACUSE NY 132031899 SANDRA SULIK PRESIDENT 5.00 35.00 X X 0 389980 13812 KATHRYN RUSCITTO SECRETARY 5.00 35.00 X 0 1092475 29750 DERRICK MURRAY COO THROUGH 5/1/2015 40.00 X 72139 0 0 FREDERICK LETOURNEAU ASSISTANT SECRETARY 5.00 35.00 X 0 355766 28654 THOMAS CERTO ASSISTANT VP 40.00 X 458588 0 0 JULIANNE HIMES COO BEGINNING 5/1/2015 40.00 X 146983 0 0 KARA KORT ASSISTANT VP 40.00 X 500492 0 0 ATUL MAINI MD 40.00 X 536216 0 0 BALASUBRAMANIAN SIKAKUMAR MD 40.00 X 497989 0 0 TRAVIS WEBB MD 40.00 X 421495 0 0 2633902 1838221 72216 57 0 1 0 MAGNETIC RESONANCE IMAGING 4567 CROSSROADS PARK DRIVE LIVERPOOL NY 13088 MEDICAL SERVICES 267856 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60673 TECHNOLOGY SERVICES 149224 GLAXOSMITHKLINE PHARMACEUTICAL PO BOX 740415 ATLANTA GA 30374 PHARMACEUTICAL 145153 IMMEDIATE MAILING 245 COMMERCE BLVD LIVERPOOL NY 13088 PRODUCE AND MAIL PATIENT STMTS 120504 4 PATIENT SERVICE REVENUE 621110 31494298 31494298 31494298 22073 22073 92416 90957 1459 1459 1459 INTERCOMPANY REIMBURSEMENTS 999999 3666124 3666124 NONPATIENT PROGRAM REVENUE 999999 1556882 1556882 EQUITY IN EARNINGS OF ST. JOSEPH' 999999 786046 786046 584966 584966 6594018 38111848 38088316 1459 22073 1178202 1178202 26436958 26436958 5011684 5011684 1676825 1676825 245292 245292 26760 26760 31083 31083 43741 43741 226635 226635 3516442 3516442 38151 38151 755540 755540 803598 803598 36714 36714 SUPPLIES 3266770 3266770 PURCHASED SERVICES 1698339 1698339 CONTRACTS AND AGREEMENT 851130 851130 COMMON AREA EXPENSE 723433 723433 2268091 2268091 48835388 48590096 245292 0 1164949 2721012 3807098 3172634 35062 617073 354929 2301799 417030 1817201 1884769 2525155 3917869 26361134 149333 329400 329400 36622010 12565008 2701336 3023209 23711819 21724590 834015 587300 27247170 25335099 X 10 10 0 0 9374830 -12770101 9374840 -12770091 36622010 12565008 X -10723540 -11421391 X X 0 1 X 1 0 X X 1 ST JOSEPH'S HOSPITAL HEALTH CENTER 150532254 3 1 0 10723540 1 0 10723540 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 21500 1005 20495 2280299 416025 1864274 1884769 INVESTMENT IN JV IMAGING 3917869 C 3917869 DEFERRED TAXES LIABILITY 475300 DUE TO DR. CERTO 56000 DUE TO DR. KUMAR 56000 587300 X PART X, LINE 2: THE HOSPITAL, SJPHPC, SJMPC AND CNY AIM ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("CODE") AND ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE. BOTH SJPHPC AND SJMPC ARE SUBJECT TO TAX FOR NYS INCOME TAX PURPOSES, DUE TO LAWS SURROUNDING THE CORPORATE PRACTICE OF MEDICINE. SJHACO IS A SINGLE MEMBER LIMITED LIABILITY CORPORATION AND AS SUCH IS TREATED AS A DISREGARDED ENTITY FOR TAX PURPOSES. THE ACTIVITIES OF SJHACO WILL BE REPORTED IN THE INCOME TAX RETURN OF THE HOSPITAL, AS ITS SOLE MEMBER. SJM IS A PARTNER IN SJLS AND AS SUCH, INCOME FROM SJLS IS PASSED THROUGH TO SJM AND ITS OTHER MEMBERS FOR INCLUSION IN THEIR RESPECTIVE TAX RETURNS. THE INCOME ALLOCATED TO SJM FROM SJLS IS CONSIDERED TO BE EXEMPT-PURPOSE INCOME TO SJM. SJPE IA A FOR-PROFIT ENTITY SUBJECT TO FEDERAL AND STATE INCOME TAXES. AS OF DECEMBER 31, 2015 AND 2014, THE HEALTH CENTER DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2012 THROUGH 2015. X 0 1 0 0 0 0 0 0 0 SANDRA SULIK PRESIDENT 0 346906 0 2146 0 40928 0 13812 0 0 0 403792 0 0 KATHRYN RUSCITTO SECRETARY 0 648812 0 113009 0 330654 0 6454 0 23296 0 1122225 0 0 FREDERICK LETOURNEAU ASSISTANT SECRETARY 0 314758 0 0 0 41008 0 12515 0 16139 0 384420 0 0 THOMAS CERTO ASSISTANT VP 458588 0 0 0 0 0 0 0 0 0 458588 0 0 0 KARA KORT ASSISTANT VP 500492 0 0 0 0 0 0 0 0 0 500492 0 0 0 ATUL MAINI MD 536216 0 0 0 0 0 0 0 0 0 536216 0 0 0 BALASUBRAMANIAN SIKAKUMAR MD 497989 0 0 0 0 0 0 0 0 0 497989 0 0 0 TRAVIS WEBB MD 421495 0 0 0 0 0 0 0 0 0 421495 0 0 0 PART I LINE 4B AFTER-TAX 457(B/F) PLAN ELIGIBILITY FOR THE AFTER-TAX 457(B/F) PLAN SHALL BE LIMITED TO THOSE INDIVIDUALS WHO ARE PRIMARILY UPPER MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES OF THE HOSPITAL WHO ARE SELECTED IN THE SOLE DISCRETION OF THE HOSPITAL'S BOARD OF TRUSTEES OR ITS DESIGNEE. ELIGIBLE EMPLOYEES WHO HAVE BEEN SELECTED BY THE EXECUTIVE COMMITTEE OF THE BOARD ARE SET FORTH ON EXHIBIT A OF THE PLAN. ALL EMPLOYER CONTRIBUTIONS TO THE PLAN ARE IMMEDIATELY VESTED. THIS PLAN IS AN INCENTIVE TO CONTINUE TO PROVIDE VALUABLE SERVICES TO THE HOSPITAL AND AS AN INCENTIVE TO RECRUIT NEW EMPLOYEES TO PROVIDE NEEDED HEALTHCARE SERVICES TO THE COMMUNITY, AND AS SUCH IS REVIEWED ON AN ANNUAL BASIS BY THE COMPENSATION COMMITTEE. PARTICIPANTS SANDRA SULIK, MD $ 17,582 FREDERICK LETOURNEAU $ 29,608 FORM 990, PART III, LINE 2 IN OCTOBER OF 2015, THE MEDICAL PC HIRED AN INTERVENTIONAL SPINE SPECIALIST TO BE ABLE TO PROVIDE SPINE CARE SERVICES TO THE COMMUNITY. THE PROGRAM WILL ALLOW THE SPINE MD TO COLLABORATE WITH REFERRING PROVIDERS AT THE ONSET OF ACUTE SPINE PAIN THROUGH DEVELOPMENT AND COORDINATION OF TREATMENT PLANS; ADDRESSING ACUTE PAIN AT EARLY ONSET CAN HELP PATIENTS AVOID FUTURE ISSUES WITH CHRONIC PAIN AND NARCOTIC DEPENDENCY, IMPROVING QUALITY OF LIFE. FORM 990, PART VI, SECTION A, LINE 1 ST. JOSEPH'S MEDICAL, P.C. IS A NEW YORK STATE PROFESSIONAL SERVICES CORPORATION WHICH IS A TAX EXEMPT CAPTIVE P.C. THE SOLE SHAREHOLDER, SANDRA M. SULIK, M.D. IS THE VICE PRESIDENT FOR MEDICAL AFFAIRS OF ST. JOSEPH'S HOSPITAL HEALTH CENTER, A SECTION 501(C)(3), 431 BED ACUTE CARE HOSPITAL. PURSUANT TO ST. JOSEPH'S MEDICAL, P.C.'S BY-LAWS, THE BOARD OF TRUSTEES OF THE HOSPITAL IS REQUIRED TO APPOINT A PRIMARY CARE OVERSIGHT AND COMPENSATION ADVISORY COMMITTEE ("ADVISORY COMMITTEE") TO MAKE RECOMMENDATIONS TO THE CORPORATION'S BOARD OF DIRECTORS ON THE FOLLOWING ISSUES: (1) IMPLEMENTING AND EVALUATING COMPENSATION USING NATIONAL SURVEYS FOR ALL PHYSICIAN-EMPLOYEES; (2) IMPLEMENTING AND EVALUATING THE CORPORATION'S BUDGET; (3) PROVISION OF MANAGEMENT, ADMINISTRATIVE AND BILLING SERVICES; (4) ESTABLISHMENT OF ADDITIONAL PRACTICE LOCATIONS; (5) LEVEL AND QUALITY OF COMMUNITY SERVICES PROVIDED BY PHYSICIAN-EMPLOYEES; (6) DECISIONS INVOLVING COST EFFICIENT OPERATIONS; (7) LONG-RANGE PLANNING; AND (8) ACTIONS REQUIRED FOR THE CORPORATION TO OPERATE IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND TO OBTAIN AND MAINTAIN ITS TAX-EXEMPT STATUS PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3). THE CURRENT MEMBERS OF THE ADVISORY COMMITTEE OF ST. JOSEPH'S MEDICAL, P.C. ARE SISTER MARY OBRIST, OSF, JOHN MARSHALL, LOWELL SEIFTER, MEREDITH PRICE AND SANDRA SULIK, M.D., PRESIDENT. THE ADVISORY COMMITTEE MEMBERS WERE APPOINTED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES OF ST. JOSEPH'S HOSPITAL HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE PRESIDENT OF THE ORGANIZATION IS THE SOLE SHAREHOLDER AND DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7A THE BY LAWS PROVIDE THAT DR. SULIK AS THE SOLE SHAREHOLDER HAS THE POWER TO APPOINT THE SOLE DIRECTOR OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE PC, ACCORDING TO ITS BYLAWS, HAS AN OVERSIGHT COMMITTEE THAT IS APPOINTED BY THE HOSPITAL'S BOARD OF TRUSTEES. THE MATTERS THAT THE COMMITTEE IS TO PROVIDE OVERSIGHT ON ARE SPECIFIED IN THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 990 IS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW PRIOR TO ITS SUBMISSION. 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 ORGANIZATION'S BY-LAWS ESTABLISHES A COMPENSATION ADVISORY COMMITTEE TO IMPLEMENT AND EVALUATE THE COMPENSATION. THE COMMITTEE IS RESPONSIBLE FOR ENSURING THAT THE EXECUTIVE COMPENSATION PROGRAM IS APPROPRIATE AND THAT ITS COMPENSATION AND BENEFITS ARE REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 ST. JOSEPH'S MEDICAL, P.C. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR THE FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS -11,421,391. FORM 990, PART XII, LINE 2C: DUE TO THE ACQUISITION OF THE ORGANIZATION BY TRINITY HEALTH, INC., THE ORGANIZATION HAS CHANGED ITS INDEPENDENT AUDITORS FOR THE PERIOD SUBSEQUENT TO JANUARY 1, 2016. 310 LAFAYETTE LLC 200 JEFFERSON AVE SE GRAND RAPIDS MI 49503 471987664 REAL ESTATE DE MERCY HEALTH PARTNERS ACCOUNTABLE CARE ORGANIZATION OF NEW ENGLAND LLC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 454565187 ACCOUNTABLE CARE ORGANIZATION MA SISTERS OF PROVIDENCE HEALTH SYSTEM INC AFFINIA HEALTH ACO LLC 20555 VICTOR PARKWAY LIVONIA MI 48152 473870396 ACCOUNTABLE CARE ORGANIZATION MI MERCY HEALTH PARTNERS BIG RUN URGENT CARE LTD 6150 E BROAD STREET 3RD FLOOR COLUMBUS OH 43213 311581575 MEDICAL SERVICES OH MOUNT CARMEL HEALTH SYSTEM CLR INVESTMENTS LLC 120 W HARRIS ST CADILLAC MI 49601 320008631 REAL ESTATE RENTAL & DEVELOPMENT MI TRINITY HEALTH-MICHIGAN CENTRAL OHIO SLEEP MEDICINE LLC 6150 EAST BROAD STREET COLUMBUS OH 43213 311701029 SLEEP MEDICINE SERVICES OH MOUNT CARMEL HEALTH 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