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
Continuing Care Management Services Network
Employer identification number
35-2336834
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)
Catholic Health East
232929748
501(c)(3)
No
Yes
Yes
0
(2)
Mercy Community Health
061492707
501(c)(3)
No
Yes
Yes
0
(3)
St Joseph's of the Pines
560694200
501(c)(3)
No
Yes
Yes
0
(4)
St Peter's Health Care System
222702507
9
No
Yes
Yes
0
(5)
Sisters of Providence Healthcare System
043398374
501(c)(3)
No
Yes
Yes
0
(6)
Mercy Uihlein Health Corporation
161535133
501(c)(3)
No
Yes
Yes
0
(7)
St James Mercy Health System
223127184
501(c)(3)
No
Yes
Yes
0
(8)
Maxis Health System
911940902
501(c)(3)
No
Yes
Yes
0
(9)
Saint Michael's Medical Center
262616046
3
No
Yes
Yes
0
(10)
St Francis Medical Center
223431049
3
No
Yes
Yes
0
(11)
St Mary Medical Center
231913910
3
No
Yes
Yes
0
(12)
Mercy Health System
232212638
501(c)(3)
No
Yes
Yes
0
(13)
Our Lady of Lourdes Health
222568528
501(c)(3)
No
Yes
Yes
0
(14)
St Francis Hospital
510064326
3
No
Yes
Yes
0
(15)
Pittsburgh Mercy Health
251464211
501(c)(3)
No
Yes
Yes
0
(16)
St Joseph's of The Pines
560694200
3
No
Yes
Yes
0
(17)
St Joseph's Health System
581744848
501(c)(3)
No
Yes
Yes
0
(18)
Saint Mary's Health Care
580566223
3
No
Yes
Yes
0
(19)
Mercy Medical Corp
636002215
3
No
Yes
Yes
0
(20)
Alleghany Franciscan Ministries
581492325
501(c)(3)
No
Yes
Yes
0
(21)
Holy Cross Hospital
590791028
3
No
Yes
Yes
0
(22)
Mercy Hospital Inc
590791034
3
No
Yes
Yes
0
(23)
Franciscan Eldercare Corporation
223008680
9
No
Yes
Yes
0
(24)
Mercy Health System of Maine
010484074
501(c)(3)
No
Yes
Yes
0
Total
0
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
Continuing Care Management Services Network
Employer identification number
35-2336834
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
Catholic Health East is the sole corporate member of Continuing Care Management Services Network and has authority to appoint the directors of Continuing Care Management Services Network. Certain decisions of the directors of Continuing Care Management Services Network are subject to approval by Catholic Health East.
Form 990, Part VI, Section A, line 7a
Catholic Health East approves the appointment of the members of the governing body.
Form 990, Part VI, Section A, line 7b
Catholic Health East has limited reserved powers to approve the decisions of the governing body.
Form 990, Part VI, Section B, line 11
The data for the Form 990 is gathered internally at the Catholic Health East System Office. Internal review occurs on several levels, by key members of management. In addition to the internal review process, the Form 990 is prepared and reviewed by the Catholic Health East System's external tax service provider. Catholic Health East takes steps to educate management and members of the board of Continuing Care Management Services Network on the compliance requirements mandated by Form 990. Catholic Health East continues to maintain a process to address questions or concerns surrounding tax reporting requirements and the members' responsibilities for review of the 990. A copy of the Form 990 was provided to and reviewed by the Board of Directors. The review was documented in the meeting minutes of the meeeting subsequent to the board review.
Form 990, Part VI, Section B, line 12c
The organization has adopted Catholic Health East's Policy 103, which sets forth the organization's conflict of interest policy and processes. Annually, all those serving Continuing Care Management Services Network 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 comprised of disinterested 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 utilizes Catholic Health East's process for determining compensation. As such, Continuing Care Management Services Network does not use any of the processes listed in Schedule J, Part I, Line 3. The Catholic Health East process 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 statement which details the objectives of market positioning and pay elements. The committee engages with external consultants to provide market data comparing Continuing Care Management Services Network's 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 approves the detailed performance expectations which are incorporated into the at-risk plan. All of these discussions and decisions are documented through the provision of meeting minutes.
Form 990, Part VI, Section C, line 19
The IRS Form 990 will be made available upon request, with the information on how to request the form provided on Catholic Health East's website. Catholic Health East's website also includes the Conflict of Interest Policy (which Continuing Care Management Services Network has adopted).
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.
Explanation of financial statements:
Form 990, Part XII, Line 2a & 2b:
Continuing Care Management Services Network's financial statements are part of the consolidated financial statement audit of Catholic Health East. Balances are subject to audit to the extent they are material to the consolidated financial statements, and auditing of those balances is performed to the extent necessary to issue an opinion thereon. These audited financial statements are available on the Catholic Health East website.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.