Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990, Part VI, Section A, line 6 | Saint Michael's Medical Center is the sole member. | |
| Form 990, Part VI, Section A, line 7a | Yes, Saint Michael's Medical Center approves the appointment of the members of the governing body. | |
| Form 990, Part VI, Section A, line 7b | Yes, Saint Michael's Medical Center can approve the decisions of the governing body. | |
| Form 990, Part VI, Section B, line 11 | The organization took steps to educate management, members of the board, and members of appropriate subcommittees of the board on the compliance requirements mandated by the Form 990. The form was reviewed by management. It will be submitted to the board or a subcommittee thereof which will report its findings to the board. The governing body did receive a copy of the Form 990 prior to filing. | |
| Form 990, Part VI, Section B, line 12c | The organization has adopted CHE's Policy 103 which sets forth the organization's conflic- of-interest policy and processes. Annually, all those serving in a fiduciary capacity, including directors, officers, and key employees receive a copy of the policy and annual disclosure statement to be completed. Disclosures of financial interest or other reportable circumstances as defined in the policy are submitted and reviewed by the organization's CEO and Board Chair. Summary information is reported to the entire board and available to the board throughout the year as business comes before the board or management for action. The policy contains a continuing affirmative obligation on all affected individuals to disclose compensation or other circumstances throughout the year which may rise to the level of an actual or apparent conflict. The determination of whether a disclosed financial or other interest constitutes a conflict of interest is made by the board or an appropriate committee thereof comprised of dis-interested persons and without the participation of the affected individual except to respond to questions about the disclosure. The policy further addresses the procedure for the board's further consideration of the proposed transaction/matter without the participation of the affected person and the documentation of the proceedings. Lastly, the policy addresses potential disciplinary action for violations of the policy. The policy is available to the public upon request. | |
| Form 990, Part VI, Section B, line 15 | The Organization has adopted CHE's process for determining compensation which includes the following: The board has an independent committee review and approve all elements of remuneration for all disqualified parties, as well as other key management. The board/committee has an established compensation philosophy which details the objectives of market positioning and pay elements. The committee engages with external consultants to provide market data comparing CHE roles to similarly sized health systems utilizing both title and job content comparisons. The committee reviews the market analysis, approves any salary adjustments for the executive population, considers both reasonableness and effectiveness of all remunerative programs and establishes the detailed performance expectations which are incorporated into the incentive plan. All of these discussions and decisions are documented through the provision of meeting minutes. | |
| Form 990, Part VI, Section C, line 19 | Organizational Articles of Incorporation, Corporate By-laws, governance policies believed to be of interest to the public, conflict-of-interest policy and IRS Form 990 are available upon request | |
| Form 990, Part VII, Section A: | Individuals compensated by a related organization have responsibilities and perform services for several related organizations including the filing organization. The amount of compensation appearing in Columns (E) and (F) reflect the services performed for this organization and its affiliates. |
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