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
BENEFIS HEALTHCARE FOUNDATION INC
Employer identification number
81-0480587
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)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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
Total
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.") ....
1,978,796
1,656,457
2,205,599
2,009,793
2,169,377
10,020,022
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
1,978,796
1,656,457
2,205,599
2,009,793
2,169,377
10,020,022
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)..
878,606
6
Public Support. Subtract line 5 from line 4.
9,141,416
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..
1,978,796
1,656,457
2,205,599
2,009,793
2,169,377
10,020,022
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
473,929
658,426
456,890
341,581
842,210
2,773,036
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
0
11
Total support (Add lines 7 through 10).
12,793,058
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
71.460 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
82.840 %
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:
10000105
Software Version:
2010v3.2
-
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
BENEFIS HEALTHCARE FOUNDATION INC
Employer identification number
81-0480587
Identifier
Return Reference
Explanation
FORM 990, PART VIII - STATEMENT OF REVENUE
PER THE INSTRUCTIONS TO FORM 990, THE VALUE OF DONATED SERVICES IS DISREGARDED FOR REPORTING PURPOSES. HOWEVER, THE FOUNDATION WOULD LIKE TO RECOGNIZE THE DONATED SERVICES IT RECEIVES, AS THEY ARE VITAL TO ITS SUCCESS. IT RECEIVED $1,008,818 IN DONATED SERVICES IN 2010. OF THIS AMOUNT, $926,251 WAS FROM BENEFIS HEATH SYSTEM IN THE FORM OF EMPLOYEES, PURCHASED SERVICES, ADVERTISING, AND OTHER MISCELLANEOUS SERVICES USED BY THE FOUNDATION.
FORM 990, PART VI, SECTION B - POLICIES
ALL POLICIES MAINTAINED AND FOLLOWED BY BENEFIS HEALTHCARE FOUNDATION ALSO APPLY TO THE FOUNDATION'S SINGLE-MEMBER LLC, BENEFIS HEALTHCARE FOUNDATION PROPERTIES, LLC.
FORM 990, PART III - ADDITIONAL DESCRIP
BENEFIS HEALTHCARE FOUNDATION CONNECTS COMPASSIONATE PEOPLE WITH THE HEALTHCARE EFFORTS THEY CARE ABOUT THE MOST. WE EXIST TO HELP DONORS IMPROVE THE QUALITY OF CARE FOR PATIENTS AT BENEFIS HEALTH SYSTEM AND PEOPLE THROUGHOUT NORTHCENTRAL MONTANA. THE FOUNDATION'S SOLE FOCUS IS HEALTHCARE - A VITAL ASPECT OF LIFE THAT AFFECTS EVERYONE.THE FOUNDATION IS ABLE TO PROVIDE INNOVATIONS AND IMPROVEMENTS IN PATIENT CARE AND SERVICES BEYOND WHAT BENEFIS, A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, CAN DO THROUGH PATIENT REVENUE ALONE.THE FOUNDATION WORKS YEAR-ROUND TO RAISE FUNDS TO SUPPORT THE DEPARTMENTS OF BENEFIS HEALTH SYSTEM AS WELL AS UNRESTRICTED FUNDS TO MEET THE GREATEST NEEDS AT BENEFIS HEALTH SYSTEM'S MEDICAL FACILITIES AND FOR COMMUNITY ORGANIZATIONS ASSISTING PEOPLE WITH HEALTH-RELATED NEEDS. WE MANAGE THESE NUMEROUS FUNDS TO ENSURE THAT EVERY DONATION, IN ITS ENTIRETY, GOES TO THE CAUSE THE DONOR CARES ABOUT THE MOST AND THEREFORE SPECIFIES.BENEFIS HEALTHCARE FOUNDATION RAISES FUNDS THROUGH A COMPREHENSIVE ARRAY OF PROGRAMS, INCLUDING: SPECIAL EVENTS, ANNUAL GIVING, PLANNED GIVING, THIRD-PARTY (COMMUNITY) FUNDRAISING EVENTS AND EMPLOYEE GIVING. WE ACCEPT A WIDE VARIETY OF GIFTS INCLUDING CASH, SECURITIES, VEHICLES, REAL ESTATE AND INSURANCE POLICIES. THE FOUNDATION ISSUES CHARITABLE GIFT ANNUITIES AND DEFERRED PAYMENT CHARITABLE GIFT ANNUITIES AS WELL AS GRATEFULLY ACCEPTS GIFTS THROUGH WILLS AND CHARITABLE TRUSTS.
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
BENEFIS HEALTHCARE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND BOARD-APPROVED POLICIES AVAILABLE TO THE PUBLIC. REQUESTS SHOULD BE MADE DURING NORMAL BUSINESS HOURS AT THE FOUNDATION OFFICE LOCATED AT 2800 11TH AVENUE SOUTH, SUITE #23, GREAT FALLS, MT.FINANCIAL STATEMENTS ARE ALSO AVAILABLE FOR DOWNLOAD ON THE ORGANIZATION'S WEBSITE, AT WWW.BENEFISFOUNDATION.ORG.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
CONFLICT OF INTEREST POLICIES ARE REVIEWED ANNUALLY BY ALL MEMBERS OF THE BOARD. UPON REVIEW, ALL MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT. THE EXECUTIVE COMMITTEE REVIEWS THE CONFLICT OF INTEREST STATEMENTS AND VERIFIES COMPLIANCE ANNUALLY.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
990 IS REVIEWED BY THE FINANCE COMMITTEE AND IS PRESENTED TO THE ENTIRE BOARD OF DIRECTORS UPON APPROVAL BY THE FINANCE COMMITTEE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.