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Nonprofiteer
← ROPER ST FRANCIS ANCILLARY SERVICES

Form 990 for tax year 2022

Filed by ROPER ST FRANCIS ANCILLARY SERVICES.

Totals

Total revenue
$841,477
Total expenses
$911,547
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$841,477
Investment income
$0
Other revenue
$0
Total assets, end of year
$313,641
Total liabilities, end of year
$212,429
Net assets or fund balances, end of year
$101,212
Program services expenses (Part IX)
$743,019
Management and general expenses
$168,528
Fundraising expenses
$0
Program service expenses (Part III)
$743,019

Program services were 81.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: Net Patient Revenue

    total $779,648 · related or exempt $779,648

  • 2b · Program service revenue: Intercompany Patient Transportation

    total $31,130 · related or exempt $31,130

  • 2c · Program service revenue: Ambulance Services

    total $30,699 · related or exempt $30,699

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $522,168 · program services $417,734 · management and general $104,434

  • 8 · Pension plan contributions

    total $47,688 · program services $38,150 · management and general $9,538

  • 9 · Other employee benefits

    total $124,128 · program services $99,302 · management and general $24,826

  • 10 · Payroll taxes

    total $34,719 · program services $27,775 · management and general $6,944

  • 11g · Fees: other

    total $133,168 · program services $117,745 · management and general $15,423 · fundraising $0

  • 12 · Advertising and promotion

    total $1,133 · program services $906 · management and general $227

  • 13 · Office expenses

    total $9,441 · program services $7,553 · management and general $1,888

  • 14 · Information technology

    total $13,930 · program services $11,144 · management and general $2,786

  • 16 · Occupancy

    total $7,480 · program services $5,982 · management and general $1,498

  • 24a · Other expenses: Medical Supplies

    total $964 · program services $964

  • 24b · Other expenses: Sales Tax

    total $3,906 · program services $3,125 · management and general $781

  • 24c · Other expenses: Vehicle Fuel

    total $11,908 · program services $11,908

  • 24e · All other expenses

    total $914 · program services $731 · management and general $183 · fundraising $0

Balance sheet

Part X, book values.

  • 4 · Accounts receivable

    end of year $313,641

  • 5 · Loans and receivables from officers and key people

    end of year $0

  • 6 · Loans and receivables from disqualified persons

    end of year $0

  • 10a · Land, buildings and equipment: cost or other basis

    $0

  • 10b · Land, buildings and equipment: accumulated depreciation

    $0

  • 10c · Land, buildings and equipment, net

    end of year $0

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $0 · end of year $0

  • 17 · Accounts payable and accrued expenses

    end of year $32,482

  • 22 · Loans and payables to officers and key people

    end of year $0

  • 25 · Other liabilities

    beginning of year $0 · end of year $179,947

  • 27 · Net assets without donor restrictions

    end of year $101,212

Mission and programs · 2022

Mission

As an operating subsidiary of Roper St. Francis Healthcare (RSFH), Roper St. Francis Ancillary Services (RSFAS) provides a wide range of healthcare services to support the work of the four hospitals that are part of the Roper St. Francis Healthcare (RSFH) System. The activities of RSFAS are devoted to fulfilling the healthcare mission of RSFH. These activities allow RSFH to extend our nonprofit mission into the community as we expand our reach and strengthen our support to those served. RSFAS services can be classified as medical, diagnostic and therapeutic. Medical services include but are not limited to patient transport, nursing, wound care, social work and virtual care. Diagnostic services include laboratory tests, diagnostic imaging and other services that render a medical diagnosis. Therapeutic services include physical rehabilitation, counseling and other services that support patient recovery and resumption of quality of life.

Activities or mission (Part I)

Medical, diagnostic and therapeutic healthcare services

  • Roper St. Francis Ancillary Services (RSFAS) provides a wide range of healthcare services to support the work of the four hospitals that are part of the Roper St. Francis Healthcare System. These services can be classified as medical, diagnostic and therapeutic. Medical services include but are not limited to patient transport, nursing, wound care, social work and virtual care. Diagnostic services include laboratory tests, diagnostic imaging and other services that render a medical diagnosis. Therapeutic services include physical rehabilitation, counseling and other services that support patient recovery and resumption of quality of life.

    Expenses $743,019 · Revenue $841,477

As filed on the 2022 return.

Listed in Part VII

  • Adriana Day

    CFO/Treasurer RSFH

    Total calculated
    $751,160
    From this org
    $0
    From related orgs
    $582,719
    Other
    $168,441
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $484,665 related
    Bonus
    $0 + $116,946 related
    Other
    $0 + -$18,892 related
    Deferred
    $0 + $137,654 related
    Nontaxable benefits
    $0 + $30,787 related
    Filer's total
    $0 + $751,160 related

  • Marissa Blair Jamarik

    SVP & Chief Nursing Officer

    Total calculated
    $561,861
    From this org
    $0
    From related orgs
    $440,371
    Other
    $121,490
    Hours/week
    25 + 25 related

    Schedule J breakdown matched by us

    Base
    $0 + $366,533 related
    Bonus
    $0 + $88,535 related
    Other
    $0 + -$14,697 related
    Deferred
    $0 + $89,933 related
    Nontaxable benefits
    $0 + $31,557 related
    Filer's total
    $0 + $561,861 related

  • Troy Powell

    VP Post Acute Care Services

    Total calculated
    $513,461
    From this org
    $0
    From related orgs
    $428,007
    Other
    $85,454
    Hours/week
    8 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $309,763 related
    Bonus
    $0 + $116,890 related
    Other
    $0 + $1,354 related
    Deferred
    $0 + $39,468 related
    Nontaxable benefits
    $0 + $45,986 related
    Filer's total
    $0 + $513,461 related

  • Kishma Rollins

    Clinical Manager

    Total calculated
    $150,911
    From this org
    $132,191
    From related orgs
    $0
    Other
    $18,720
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $120,351
    Bonus
    $11,283
    Other
    $557
    Deferred
    $5,680
    Nontaxable benefits
    $13,040
    Filer's total
    $150,911

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation
A related organization of Roper St. Francis Ancillary Services Inc. determined the compensation of the Organization's CEO using the following methods: Compensation Committee Independent Compensation Consultant Compensation Survey or Study Approval by the Board or Compensation Committee
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
The Roper St. Francis Healthcare 457(f) Plan's purpose is to offer eligible employees of the employer deferred compensation benefits to supplement Eligible Employees' retirement income. The Plan is intended to be a top-hat plan (i.e. an unfunded deferred compensation plan maintained for certain members of a select group of management or highly compensated employees). INDIVIDUALS THAT PARTICIPATED OR RECEIVED A DISTRIBUTION INCLUDE: Troy Powell, $0; Marissa Jamarik, $0; Adriana Day, $0.
Schedule J, Part I, Line 7 NON-FIXED PAYMENTS
Goals are developed each year to support the Organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports it to the full Board of Directors. Progress on each metric is reported to the Board each month on the corporate scorecard. At year-end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full Board. Annual incentives for the executives are based 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

Provenance

Return type
form_990
Tax year
2022
Filed
1 November 2023
IRS schema version
2022v5.0
Source object
202313059349301036

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