Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ST JOSEPH FOUNDATION OF BRYAN TEXAS
Employer identification number
74-2351158
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
ST JOSEPH REGIONAL HEALTH CENTER
741282696
03
Yes
Yes
392,535
(2)
MADISON ST JOSEPH HEALTH CENTER
742761145
03
Yes
Yes
2,493
(3)
BURLESON ST JOSEPH HEALTH CENTER
742759890
03
Yes
Yes
0
(4)
BURLESON ST JOSEPH MANOR
742913931
09
Yes
Yes
0
(5)
ST JOSEPH MANOR
742847594
09
Yes
Yes
0
(6)
ST JOSEPH SERVICES CORPORATION
742455161
03
Yes
Yes
0
(7)
ST JOSEPH PHYSICIAN ASSOCIATES
203159302
03
Yes
Yes
0
Total
395,027
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ST JOSEPH FOUNDATION OF BRYAN TEXAS
Employer identification number
74-2351158
Identifier
Return Reference
Explanation
Description of Classes of Members or Stockholders
Form 990, Part VI, 6
BYLAWS, SECTION 1. MEMBERSHIP THE MEMBERSHIP OF THE FOUNDATION SHALL CONSIST OF ONE (1) CLASS AND THE ONLY MEMBER OF THE FOUNDATION SHALL BE ST. JOSEPH SERVICES CORPORATION, D/B/A ST. JOSEPH HEALTH SYSTEM, A TEXAS NONPROFIT CORPORATION (HEREINAFTER REFERRED TO AS "ST. JOSEPH HEALTH SYSTEM" OR "SJHS" OR THE "MEMBER").
Members/stockholders who may elect one or more members of governing body
Form 990, Part VI, 7A & 7B
BYLAWS, SECTION 2. RESERVED POWER EXERCISABLE BY MEMBER ALONE IN ADDITION TO, AND NOT IN LIMITATION OF, THE POWERS RESERVED TO MEMBERS OF NONPROFIT CORPORATIONS BY LAW AND PURSUANT TO THE ARTICLES OF INCORPORATION AND OTHER PROVISIONS OF THESE BYLAWS, ACTION BY ST. JOSEPH HEALTH SYSTEM IN ITS CAPACITY AS SOLE MEMBER OF THE CORPORATION AND SUBJECT TO APPROVAL BY THE MEMBER OF SJHS, FRANCISCAN SERVICES CORPORATION ("FSC') WHEN REQUIRED BY THE ARTICLES OF INCORPORATION OR BYLAWS OF SJHS SHALL BE REQUIRED AND SHALL BE SUFFICIENT: A) TO ADOPT OR CHANGE THE PHILOSOPHY, OBJECTIVES, PURPOSES, OR ETHICAL OR RELIGIOUS STANDARDS OF THE FOUNDATION AND OF ORGANIZATIONS CONTROLLED BY THE FOUNDATION; B) TO APPOINT THE DIRECTORS OF THE FOUNDATION AND TO REMOVE THEM AT WILL, WITH OR WITHOUT CAUSE, AS PROVIDED IN ARTICLE IV, SECTION 2 AND 4 OF THESE BYLAWS; C) TO APPOINT AND REMOVE THE EXECUTIVE DIRECTOR AS PROVIDED IN ARTICLE VI, SECTION 6 OF THESE BYLAWS; D) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION; E) TO AMEND OR REPEAL THE BYLAWS OF THE FOUNDATION AS PROVIDED IN ARTICLE XIII OF THESE BYLAWS; F) TO DISSOLVE OR TERMINATE THE EXISTENCE OF THE FOUNDATION AND TO DETERMINE THE DISTRIBUTION OF ASSETS UPON SUCH DISSOLUTION OR TERMINATION IN ACCORDANCE WITH THE ARTICLES OF INCORPORATION; AND G) TO TAKE ANY ACTION NECESSARY TO CONFORM THE PURPOSES AND ACTIVITIES OF THE FOUNDATION WITH THE TRADITIONS, TEACHINGS AND CANON LAW OF THE ROMAN CATHOLIC CHURCH AS MAY BE IN EFFECT FROM TIME TO TIME.
Describe the Process used by Management &/or Governing Body to Review 990
Form 990, Part VI, Question 11
2010 FORM 990 AND ACCOMPANYING SCHEDULES WERE MADE AVAILABLE TO ALL TRUSTEES EITHER ELECTRONICALLY OR BY HARD COPY, DEPENDING UPON THE TRUSTEE'S PREFERENCE, BEFORE THE COMPANY FINALIZED AND SENT THE DOCUMENTS TO IRS. THIS DRAFT WAS ALSO AVAILABLE AT THE ADMINISTRATIVE OFFICES OF THE REPORTING ENTITY FOR TRUSTEE'S REVIEW BEFORE THE FINAL 2010 FORM 990 AND ACCOMPANYING SCHEDULES WERE FINALIZED AND SENT TO IRS. THE REVIEW WAS UNDER THE DIRECTION OF THE CFO AND/OR TAX RETURN PREPARERS, ERNST & YOUNG, IF REQUESTED BY TRUSTEE.
Description of Process to Monitor Transactions for Conflicts of Interest
Form 990, Part VI, Question 12c
IN ACCORDANCE WITH ST. JOSEPH HEALTH SYSTEM POLICY NO.38, "CONFLICT OF INTEREST," SECTION 6: DISCLOSURE STATEMENT: "..A CONFLICT OF INTEREST STATEMENT SHALL BE EXECUTED BY ALL DESIGNATED PERSONS, WHICH WILL BE RETAINED BY THE CORPORATION IN ITS ADMINISTRATIVE OFFICE, THIS STATEMENT SHALL BE RENEWED AT LEAST ANNUALLY AT THE REQUEST OF THE CORPORATION AND AT ANY TIME THAT A CONFLICT OF INTEREST MAY ARISE." TO HELP ENSURE THAT DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY ALL BOARD OF TRUSTEE MEMBERS, THE CEO'S OFFICE SUMMARIZES ALL CONFLICTS OF INTEREST DISCLOSED BY EACH ENTITY'S TRUSTEES. IN 2010, THE SUMMARY WAS PRESENTED AS AN AGENDA ITEM AT EACH ENTITY'S BOARD OF TRUSTEES MEETING HELD IN APRIL 2010. THE REVIEW IS PERFORMED BY THE OFFICE OF THE CEO WHERE DISCLOSURE STATEMENTS ARE ALSO FILED FOR TRUSTEES. OTHER DESIGNATED PERSONS' DISCLOSURE STATEMENTS ARE FILED IN INDIVIDUAL PERSONNEL FILES IF EMPLOYED BY SJRHC. WHISTLEBLOWER POLICY AND DOCUMENT RETENTION AND DESTRUCTION POLICY FORM 990, PART VI, LINES 13 AND 14 The organization follows the policies of the St. Joseph Health System to which it is an affiliate. The policy in that includes the whistleblower policy and the document retention and destruction policy are documented and are approved by the President and CEO of the System. The bylaws of St. Joseph Health System state: "...The President/CEO shall have all authority and responsibility necessary to operate the Corporation in all its activities and departments, subject only to such policies as may be issued by the board. The President/CEO shall act as a duly authorized representative of the Board and of the Corporation in all matters in which the Board has not formally designated some other person to act..." Therefore, the President/CEO by the authority granted to him in the above paragraph approves the policies. During the last 2011 St. Joseph Health System board meeting the two policies will be approved by the Board.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public
Form 990, Part VI, Question 19
NOT MADE AVAILABLE TO PUBLIC.
OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
EQUITY TRANSFER $800,000 UNREALIZED LOSS ON INVESTMENTS 6,039 DONATED SERVICES 47,631 ------- $853,670
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ANTHONY PFITZER TITLE:EX-OFFICIO DIRECTOR HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LISA MCNAIR TITLE:TREASURER HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.