2015-11-16T11:02:21-06:00 2014-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2014-01-01 273899821 ST JOSEPH'S MEDICAL PC STJO 3157032106 301 PROSPECT AVENUE SYRACUSE NY 13203 SANDRA SULIK PRESIDENT 3157032106 2015-11-13 1 ANGELA M FRANCO P00589741 3154463600 2014 2016-04-25 22:37:26Z SANDRA M SULIK 301 PROSPECT AVENUE SYRACUSE NY 13203 33829152 0 X WWW.SJPHYSICIANS.ORG X 2010 NY TO PROVIDE PRIMARY AND SPECIALTY PROFESSIONAL MEDICAL SERVICES TO THE COMMUNITY. 1 0 729 3 3653 2653 0 0 36549395 29706959 0 925882 512527 3097396 37061922 33730237 0 0 0 0 26806484 32014283 0 0 0 14082572 13934959 40889056 45949242 -3827134 -12219005 37606671 36622010 31564019 27247170 6042652 9374840 X TO PROVIDE PRIMARY AND SPECIALTY PROFESSIONAL MEDICAL SERVICES TO THE COMMUNITY 1 1 45824949 32800702 ST. JOSEPH'S MEDICAL, P.C. IS A NEW YORK STATE PROFESSIONAL SERVICES CORPORATION AFFILIATED WITH THE HOSPITAL WHOSE MISSION IS TO PROVIDE PRIMARY AND SPECIALTY PROFESSIONAL MEDICAL SERVICES TO THE COMMUNITY. ST. JOSEPH'S MEDICAL, P.C. CONSISTS OF SIX PRACTICE LOCATIONS (FAMILY MEDICINE, URGENT CARE, SURGICAL, ORTHOPEDIC,BEAST SURGERY) WHICH GENERATED NEARLY 274,962 PATIENT VISITS. 45824949 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 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 89 0 1 729 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/ TREASURER 5.00 35.00 X X 0 363318 9533 KATHRYN RUSCITTO SECRETARY 5.00 35.00 X 0 886535 30866 SISTER MARY OBRIST ASSISTANT TREASURY 5.00 35.00 X 0 0 0 DERRICK MURRY CHIEF OPERATING OFFICER 40.00 X 169599 0 0 FREDERICK LETOURNEAU ASSISTANT SECRETARY 5.00 35.00 X 0 385261 23923 ATUL MAINI MD 40.00 X 570802 0 0 BALASUBRAMANIAN SIKAKUMAR MD 40.00 X 519287 0 0 THOMAS CERTO MD 40.00 X 495918 0 0 ANTHONY OLIVA MD 40.00 X 360164 0 0 JAMES TUCKER MD, BEGINNING 5/1/2014 40.00 40.00 X 257852 145099 8797 2373622 1780213 73119 56 0 1 0 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 606731246 HEALTHCARE INFORMATION TECHNOLOGY SOLUTI 395171 VERSOGENICS (DBA COMFORCE) 3492 MOMENTUM DRIVE CHICAGO IL 606895334 HEALTHCARE BUSINESS SOLUTIONS 219862 PROSPECT HILL RADIOLOGY 104 UNION AVENUE SUITE 905 SYRACUSE NY 13203 RADIOLOGY SERVICES 154365 11 PATIENT SERVICE REVENUE 621110 29706959 29706959 29706959 2628 2628 102568 98915 3653 3653 3653 923254 0 923254 923254 923254 OTHER INCOME 999999 1200508 1200508 INTERCOMPANY REIMBURSEMENTS 999999 1056063 1056063 EQUITY IN EARNINGS OF ST. JOSEPH' 999999 837172 837172 3093743 33730237 32800702 3653 925882 169599 169599 26308834 26308834 4149635 4149635 1386215 1386215 124293 124293 83174 83174 49744 49744 52963 52963 364734 364734 3046122 3046122 41847 41847 848902 848902 520163 520163 1081227 1081227 SUPPLIES 2939551 2939551 CONTRACTS AND AGREEMENT 1387645 1387645 COMMON AREA EXPENSE 634251 634251 MAINTENANCE & REPAIRS 374588 374588 2385755 2385755 45949242 45824949 124293 0 2433149 1164949 4887893 3807098 1081634 617073 3381789 1564588 2438194 1817201 2525155 26435801 26361134 330000 329400 37606671 36622010 2842090 2701336 25926984 23711819 2794945 834015 31564019 27247170 X 10 10 0 0 6042642 9374830 6042652 9374840 37606671 36622010 X -12219005 15551193 X X 0 1 X 1 0 X X 1 ST JOSEPH'S HOSPITAL HEALTH CENTER 150532254 3 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 21500 5044 16456 3360289 1559544 1800745 1817201 INVESTMENT IN JV IMAGING 2525155 C 2525155 DUE TO ST JOSEPH'S PROPERTIES -33194 DUE TO ST. JOSEPH'S IMAGING -299 DUE TO ST. JOSEPH'S FOUNDATION 224208 DEFERRED TAXES LIABILITY 475300 DUE TO DR. CERTO 84000 DUE TO DR. KUMAR 84000 834015 X 33743820 -85332 -85332 33829152 -98915 -98915 33730237 45962825 -85332 -85332 46048157 -98915 -98915 45949242 PART X, LINE 2: ST. JOSEPH'S MEDICAL P.C. IS A PROFESSIONAL SERVICE CORPORATION UNDER ARTICLE 15 OF THE BUSINESS CORPORATION LAW AND IS INTENDED TO OPERATE AT ALL TIMES IN COMPLIANCE WITH THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(C)(3). DURING AUGUST 2014, THE COMPANY WAS GRANTED TAX-EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE FOR FEDERAL PURPOSES. FOR NEW YORK STATE, THE COMPANY IS TAXED ON INCOME GENERATED FROM PROFESSIONAL SERVICES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CREDIT CARD FEES -85,332. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -98,915. PART XII, LINE 2D - OTHER ADJUSTMENTS: CREDIT CARD FEES -85,332. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -98,915. X 0 1 0 0 0 0 0 0 0 SANDRA SULIK PRESIDENT/ TREASURER 0 302765 0 43646 0 16907 0 9533 0 0 0 372851 0 0 KATHRYN RUSCITTO SECRETARY 0 653952 0 100775 0 131808 0 6264 0 24602 0 917401 0 0 DERRICK MURRY CHIEF OPERATING OFFICER 169599 0 0 0 0 0 0 0 0 0 169599 0 0 0 FREDERICK LETOURNEAU ASSISTANT SECRETARY 0 314995 0 37603 0 32663 0 8392 0 15531 0 409184 0 0 ATUL MAINI MD 570802 0 0 0 0 0 0 0 0 0 570802 0 0 0 BALASUBRAMANIAN SIKAKUMAR MD 519287 0 0 0 0 0 0 0 0 0 519287 0 0 0 THOMAS CERTO MD 495918 0 0 0 0 0 0 0 0 0 495918 0 0 0 ANTHONY OLIVA MD 360164 0 0 0 0 0 0 0 0 0 360164 0 0 0 JAMES TUCKER MD, BEGINNING 5/1/2014 257852 145099 0 0 0 0 8441 0 233 123 266526 145222 0 0 PART I, LINE 4B AFTER-TAX 457(F) PLAN ELIGIBILITY FOR THE AFTER-TAX 457(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 KATHRYN RUSCITTO $130,805 FREDERICK LETOURNEAU $ 26,775 DR. SANDRA SULIK $ 14,217 FORM 990, PART III, LINE 2 IN SEPTEMBER 2014, THE MEDICAL PC MADE A STRATEGIC DECISION TO HIRE A BREAST SURGEON SPECIALIZING IN BREAST DISEASE AND TREATMENT TO FURTHER DEVELOP THEIR CURRENT BREAST CARE PROGRAM TO BETTER SERVE THESE PATIENTS. THE MISSION OF THE BREAST CARE PROGRAM IS TO PROVIDE AN ORGANIZED, COMPREHENSIVE, MULTIDISCIPLINARY TEAM APPROACH TO BREAST CARE TO IMPROVE CLINICAL AND PSYCHOLOGICAL OUTCOMES FOR ALL PATIENTS. THE PROGRAM INCLUDES A HIGHLY SKILLED TEAM OF PHYSICIANS LEAD BY DR. KORT AND NURSE NAVIGATORS TO GUIDE AND SUPPORT EACH PATIENT THROUGH THE TREATMENT AND SURVIVORSHIP PROCESS. THE MULTISPECIALTY ENSURES COORDINATION OF CARE BETWEEN SURGERY, RADIOLOGY, PATHOLOGY, MEDICAL AND RADIATION ONCOLOGY. FORM 990, PART III, LINE 3 IN PRIOR YEARS AND PRIOR TO MARCH OF 2014, THE MEDICAL PC HAD A GYN PRACTICE. THE PRACTICE WAS SET UP TO PROVIDE GYNECOLOGY SERVICES TO THE COMMUNITY. IN 2014, THE MEDICAL PC DETERMINED THAT THE DEMAND FOR THE SERVICES OF THE PROVIDERS IN THE PRACTICE WERE NOT ENOUGH TO SUPPORT THE COST OF THE PRACTICE. THE FOUR PROVIDERS EMPLOYED BY THE PRACTICE LEFT TO PURSUE WORK IN OTHER INDEPENDENT PRACTICES. 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 TRANSFER 15,551,193. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ST JOSEPH'S HOSPITAL HEALTH CENTER 301 PROSPECT AVE SYRACUSE NY 13203 150532254 TEACHING HOSPITAL NY 501 (C)(3) 3 ST JOSEPH'S HEALTH INC 0 ST JOSEPH'S HOSPITAL FOUNDATION 301 PROSPECT AVE SYRACUSE NY 13203 222149775 FUNDRAISING FOR HOSPITAL NY 501 (C)(3) 11A ST JOSEPH'S HEALTH INC 0 ST JOSEPH'S HOSPITAL PROPERTIES 301 PROSPECT AVE SYRACUSE NY 13203 237219294 PROPERTY MANAGEMENT COMPANY NY 501 (C)(3) 11A ST JOSEPH'S HEALTH INC 0 SJ MANAGEMENT COMPANY OF SYRACUSE INC 301 PROSPECT AVE SYRACUSE NY 13203 271763712 SUPPORT ST. JOSEPH'S HOSPITAL HEALTH CENTER NY 501 (C)(3) 11C ST JOSEPH'S HOSPITAL HEALTH CENTER 0 ST JOSEPH'S PHYSICIAN HEALTH PC 301 PROSPECT AVE SYRACUSE NY 13203 161516863 PHYSICIAN PROFESSIONAL SERVICES NY 501 (C)(3) 11B ST JOSEPH'S HOSPITAL HEALTH CENTER 0 ST JOSEPH COLLEGE OF NURSING AT SJHHC 206 PROSPECT AVENUE SYRACUSE NY 13203 202497520 NURSING EDUCATION NY 501 (C)(3) 11A ST JOSEPH'S HOSPITAL HEALTH CENTER 0 ST JOSEPH'S HEALTH INC 301 PROSPECT AVE SYRACUSE NY 13203 474754987 PARENT COMPANY TO THE HOSPITAL, PROPERTIES AND FOUNDATION NY 501 (C)(3) 11A PARTNERS IN FRANCISCAN MINISTRIES INC 0 FRANCISCAN ASSOCIATES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 202991688 HOLDING COMPANY NY ST JOSEPH'S HOSPITAL PROPERTIES C 0 FRANCISCAN MANGEMENT SERVICES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 161351193 MANAGEMENT SERVICES NY FRANCISCAN ASSOCIATES INC C 0 FRANCISCAN HEALTH SUPPORT INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 161236354 DURABLE MEDICAL EQUIPMENT NY FRANCISCAN ASSOCIATES INC C 0 HEALTH CARE MANAGEMENT ADMINISTRATORS INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 161450960 MANAGEMENT AND BILLING SERVICES NY FRANCISCAN ASSOCIATES INC C 0 FHS SERVICES INC 333 BUTTERNUT DRIVE SUITE 100 DEWITT NY 13214 272995699 HEALTH SERVICE PROVIDER NY FRANCISCAN ASSOCIATES INC C 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 1 1 0 1