2014-07-10T08:52:20-05:00 2013-08-31 990 2012-09-01 134290167 St Francis Physician Services Inc STFR 8642551000 One St Francis Drive Greenville SC 29601 Ronnie Hyatt 8642551000 2014-07-10 0 2012 2015-11-30 17:44:51Z Bon Secours Express Care Mark Nantz One St Francis Drive Greenville SC 29601 142363255 0 X www.stfrancishealth.org X 2004 SC Primary, urgent, and specialty care 12 4 1376 4 0 0 0 0 133976483 142262334 0 0 254104 71580 134230587 142333914 0 0 0 0 125160800 133539876 0 0 0 43523069 48001939 168683869 181541815 -34453282 -39207901 28945699 29457688 169351048 209070938 -140405349 -179613250 X The mission is to bring compassion to health care and to be good help to those in need, especially those who are poor and dying. As a system of caregivers, we commit ourselves to help bring people and communities to health and wholeness. St. Francis Physician Services, Inc. serves this mission as the vehicle for physician employment relationships in the Bon Secours St. Francis Health System, Inc. 0 0 163834942 142262334 St. Francis Physician Services, Inc. (SFPS) operates as an affiliate model in the provision of services to the residents of Greenville, South Carolina and the surrounding communities including primary care, urgent care, and various specialties. A member of Bon Secours St. Francis Health System, Inc., SFPS continues to expand to meet the needs of the community residents. The various practices that comprise SFPS are strategically located with the area to most effectively meet the needs of the community. 163834942 1 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 159 0 1 1376 1 0 0 0 0 0 0 0 0 0 0 X 12 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Ronnie Hyatt CFO 8642551000 One St Francis Drive Greenville SC 29601 X Thomas E Baumgarten MD 50.00 0.00 X 1645707 0 41891 Stacy Bizzell MD 50.00 0.00 X 249935 0 36850 Brother Peter Campbell CFX 0.50 2.00 X 0 0 0 Camilla Hertwig 0.50 3.00 X 0 0 0 Wayne McDonald MD 0.50 2.00 X 0 0 0 Raana Naidu MD 50.00 0.00 X 322365 0 24458 James Wallace MD 50.00 0.00 X 478317 0 44676 Fletcher Kirkland 0.50 2.00 X X 0 0 0 Thomas Morris PhD 0.50 49.50 X X 0 522375 52845 Ronnie Hyatt 8.00 42.00 X X 0 445433 32744 John S Pietras 49.90 0.10 X X 0 276478 51441 Mark Nantz 10.00 40.00 X X 0 952104 80530 Betsy Pearson 50.00 0.00 X 112545 0 13596 Courtney Ouzts 50.00 0.00 X 43817 0 24873 John R Vann 50.00 0.00 X 1603647 0 43391 Christopher Kavolus 50.00 0.00 X 1301662 0 46244 James E Jennings 50.00 0.00 X 1294225 0 43526 Michael Tollison 50.00 0.00 X 1222987 0 44015 Craig J McCotter 50.00 0.00 X 1180105 0 45468 9455312 2196390 626548 199 0 1 0 Zirmed 1311 Solutions Center Chicago IL 606771311 Claims Filing 437052 Philips Healthcare PO Box 100355 Atlanta GA 303840355 Equip Maint Contracts 333634 Digital Transcription Inc 100 Iverson Street Greenville SC 296151937 Transcription 189147 Godshall & Godshall Personnel Consultant PO Box 1984 Greenville SC 29602 Contract Labor 161506 AAPC Physician Services 2500 S 3850 W Suite D Salt Lake City UT 84120 Reimbursement Audit 131968 6 Net Patient Svc Rev. 621110 142262334 142262334 142262334 59171 29341 29830 29830 Copies of Med. Records 900099 20081 20081 Clinical Research 900099 15500 15500 Purchase Discounts 900099 6169 6169 41750 142333914 142262334 0 71580 2914530 2623078 291452 109730710 98757639 10973071 2003929 1803536 200393 12263431 11037088 1226343 6627276 5964548 662728 3810 3429 381 1496173 1346556 149617 521882 469694 52188 1321760 1189584 132176 881308 793177 88131 11423783 10281405 1142378 573150 515835 57315 40146 36131 4015 168442 168442 286057 257451 28606 2645281 2380753 264528 Medical Supplies 11923003 10730703 1192300 Purchased Services 7781000 7002900 778100 Bad Debt 4304632 4304632 Medical Equip Rental 2719787 2447808 271979 1911725 1720553 191172 181541815 163834942 17706873 0 37225 38197 11697968 10909280 47113 62742 1710843 3503105 15452550 14944364 28945699 29457688 8491650 8889354 160859398 200181584 169351048 209070938 X -140405349 -179613250 -140405349 -179613250 28945699 29457688 -39207901 0 X 0 1 X 1 1 1 X 72649000 89298745 107982858 133976483 142262334 546169420 72649000 89298745 107982858 133976483 142262334 546169420 0 0 0 546169420 4320 4320 4320 4320 317506 494906 438698 281533 100921 1633564 72970826 89793651 108421556 134258016 142363255 547807304 0.99700 0.99550 0.00000 X Schedule A, Part IV, Supplemental Information: Schedule A, Part III, Line 12, Explanation for Other Income: Physician Consulting Fees Copies of Medical Records Sales of Inventory Miscellaneous 0 LT Non-Cash HPL/GL 14638523 Non-Compete 117143 Misc A/R - Phys Services 188698 14944364 Due to BSHSI 185496753 Unclaimed Property Accrual 9382 HPL/GL Liability 14638523 LT Deferred Rent 36926 200181584 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Schedule D, Part X, Line 2 requires that the organization provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under ASC 740 (formerly FIN48). ASC 740 (formerly FIN48) addresses the accounting for uncertainty in income taxes recognized in an entity's financial statements and prescribes a threshold of more-likely-than-not for recognition and de-recognition of tax positions taken or expected to be taken in a tax return. The adoption of ASC 740 (formerly FIN48) by BSHSI on September 1, 2007 did not have a material impact on BSHSI's consolidated financial statements. As the organization does not conduct a separate audit of its financial statements, below is the related statement from the Bon Secours Health System, Inc. consolidated audited financial statements: The System and most of its subsidiaries (including certain joint venture entities) are exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The system accounts for uncertain tax positions in accordance with ASC Topic 740. Income taxes of the Systems for-profit subsidiaries are not material to the accompanying consolidated financial statements. The Systems taxable subsidiaries have approximately $66,681 and $95,733 of net operating loss carryforwards as of August 31, 2013 and 2012, respectively, which expire in varying periods through 2032 and are available to offset future taxable income. The Systems deferred tax assets are fully reserved at August 31, 2013 and 2012. Any changes to the valuation allowance on the deferred tax asset are reflected in the year of the change. 0 1 0 0 0 0 0 0 0 Thomas E Baumgarten MD 772225 0 870283 0 3199 0 15000 0 26891 0 1687598 0 0 0 Stacy Bizzell MD 187466 0 60993 0 1476 0 11700 0 25150 0 286785 0 0 0 Raana Naidu MD 220800 0 98166 0 3399 0 13439 0 11019 0 346823 0 0 0 James Wallace MD 228802 0 246528 0 2987 0 14285 0 30391 0 522993 0 0 0 Thomas Morris PhD 0 265262 0 185027 0 72086 0 33904 0 18941 0 575220 0 14543 Ronnie Hyatt 0 332771 0 68167 0 44495 0 15000 0 17744 0 478177 0 28125 John S Pietras 0 174544 0 78389 0 23545 0 23411 0 28030 0 327919 0 9300 Mark Nantz 0 546573 0 364503 0 41028 0 61960 0 18570 0 1032634 0 0 John R Vann 827432 0 768480 0 7735 0 15000 0 28391 0 1647038 0 0 0 Christopher Kavolus 848593 0 448574 0 4495 0 15000 0 31244 0 1347906 0 0 0 James E Jennings 827107 0 459383 0 7735 0 15000 0 28526 0 1337751 0 0 0 Michael Tollison 830008 0 388484 0 4495 0 15000 0 29015 0 1267002 0 0 0 Craig J McCotter 637907 0 540494 0 1704 0 15000 0 30468 0 1225573 0 0 0 Part I, Line 3 Bon Secours Health System, Inc., a related organization of the filing organization, uses the following to establish the compensation of the organization's CEO/Executive Director: Compensation Committee Independent Compensation Consultant Written Employment Contract Compensation Survey or Study Approval by the Board or Compensation Committee Part I, Line 4b The filing organization participates in a BSHSI sponsored executive retirement program that allows for deposits into additional retirement plans and available only to officers and key employees. The 457F plan is a non-qualified plan and is subject to a minimum three-year service requirement before vesting on deposits made into this plan. Individuals that received a distribution include: John S. Pietras, $16,114; Thomas Morris, PhD, $23,265; Ronnie Hyatt, $39,089. Form 990, Part VI, Section A, line 6 Bon Secours Health System, Inc. is the sole member of Bon Secours St. Francis Health System, Inc., which in turn is the sole member of St. Francis Physician Services, Inc. Form 990, Part VI, Section A, line 7a The governing body of is appointed by its member Bon Secours St. Francis Health System, Inc. and subject to approval by Bon Secours Health System, Inc. Form 990, Part VI, Section A, line 7b Certain authorities of St. Francis Physician Services, Inc. are reserved to its member or to Bon Secours Health System, Inc. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of a review by the local system's audit and compliance board-committee and providing the form to the local system board of directors to allow for a thorough review by both before the filing date. The local system's audit and compliance committee and board of directors have reviewed the Form 990, scheduled time on meeting agendas, and asked questions regarding the Form 990 before the return is filed. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors compliance with the conflict of interest policy. On an annual basis, all persons subject to the policy, including all officers, directors and key employees are required to make certain disclosures. These include disclosures related to certain personal, financial and organizational relationships that may present a conflict, or the appearance of a conflict of interest with the organization. All disclosures go through a three-part review process: (1) disclosures are reviewed first by the corporate responsibility officer (CRO); (2) a governance team comprised of the CEO, board president, board chair, CRO, and the BSHSI CRO participate in a second review of all disclosures during which recommendations are made as to the resolution of any conflicts or potential conflicts. Depending on the facts and circumstances, resolutions may include ongoing disclosure, recusal or removal of the conflict; and (3) all disclosures and recommendations are reviewed by a board committee (audit and compliance committee reviews the disclosures of management and the governance committee reviews the disclosures of the board and board committee members). Form 990, Part VI, Section B, line 15 The compensation committee of the board of Bon Secours Health System, Inc. (BSHSI) engages in a comprehensive process for the oversight and management of remuneration for executive employees and disqualified parties of the BSHSI. The compensation committee consists of a group of independent board members and engages independent external compensation consultant to ensure they receive appropriate analysis of market and follow the practices necessary to obtain full compliance with the IRS' rebuttable presumption of reasonableness. The committee establishes and maintains a compensation philosophy; reviews pay practices against local, regional and national healthcare organizations and approves all remunerative decisions for this group of individuals. The committee reviews and receives assurances that all levels of pay within the organization are reasonable based on performance and validates incentives are met. These decisions are documented in the BSHSI board of directors and compensation committee minutes. Form 990, Part VI, Section b, Line 15b - Compensation Process Other Officers/ Key Employees: For those key employees and highest paid employees that are not reviewed by the BSHSI compensation committee, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. In the review, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in human resources. Form 990, Part VI, Section C, line 19 The filing organization provides any documents open to public inspection upon request. Form 990, Part VII: Board Member positions are generally voluntary in nature. Compensated employees of the filing organization and other related organizations who also hold board positions are compensated only in relation to their employment. Bon Secours Health System Inc 1505 Marriottsville Road Marriottsville MD 21104 521301088 Parent Org. Management Services MD 501(c)(3) Line 11b, II Bon Secours Inc 0 St Francis Hospital Inc One St Francis Drive Greenville SC 29601 582504530 Health Care SC 501(c)(3) Line 3 Bon Secours St Francis Health System Inc 0 St Francis Health System Foundation Inc One St Francis Drive Greenville SC 29601 260012031 Grant Making Foundation SC 501(c)(3) Line 7 SFH Inc 0 Bon Secours St Francis Health System Inc One St Francis Drive Greenville SC 296013955 582504528 Local System Parent Org. SC 501(c)(3) Line 11b, II Bon Secours Health System Inc 0 Upstate Surgery Center One St Francis Drive Greenville SC 29601 562186977 Ambulatory Surgery Center SC N/A Health Care Enterprises Inc & Subs One St Francis Drive Greenville SC 29601 571015852 Holding Company SC N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 0 0 0