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 FRANCIS HEALTH CENTER INC
Employer identification number
48-0547719
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.") ....
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 FRANCIS HEALTH CENTER INC
Employer identification number
48-0547719
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4a
EXEMPT PURPOSE
AS PART OF THE HEALING MISSION OF THE CATHOLIC CHURCH, THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ITS AFFILIATES WITNESS TO THE GOSPEL OF JESUS BY STRIVING TO PROVIDE QUALITY HEALTH CARE IN A SPIRIT OF JUSTICE AND CHARITY. IT IS THE PHILOSOPHY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND AFFILIATED HOSPITALS TO TREAT PATIENTS IN A NON-DISCRIMINATORY MANNER; MINIMIZE HUMAN SUFFERING AS MUCH AS POSSIBLE; CREATE A PREFERENTIAL OPTION FOR THE POOR; AND PROVIDE ASSISTANCE TO THOSE PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES.
FORM 990, PART VI, SEC A, LINE 6
THE SOLE MEMBER OF ST. FRANCIS HEALTH CENTER, INC. IS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC., A KANSAS NOT-FOR-PROFIT CORPORATION (THE "CORPORATE MEMBER").
FORM 990, PART VI, SEC A, LINE 7A & 7B
ELECTION OF MEMBERS AND APPROVAL OF DECISIONS
SOME OF THE EXCLUSIVE POWERS OF SCLHS INCLUDE: (1) TO APPOINT, AFTER CONSULTATION WITH THE SFHC CORPORATE BOARD, THE BOARD OF DIRECTORS OF SFHC AND APPOINT MEMBERS OF SCLHS TO THE SFHC BOARD OF DIRECTORS; (2) TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE SFHC CORPORATE BOARD, ANY MEMBER OF THE SFHC BOARD OF DIRECTORS; (3) TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER AND THE CHIEF ADMINISTRATIVE OFFICER OF SFHC; (4) TO IMPLEMENT CORPORATE GOALS, POLICIES, AND PROCEDURES OF SFHC; (5) TO APPROVE FOR SFHC, THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE LEASE, SALE, TRANSFER, ASSUMPTION, OR ENCUMBERING OF SFHC ASSETS; (6) TO APPROVE THE MERGER, DISSOLUTION, OR CORPORATE RESTRUCTURING OF SFHC; AND (7) TO APPROVE SFHC ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS. THE SFHC BOARD OF DIRECTORS HAVE THE POWERS TO EXERCISE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AFFAIRS OF SFHC WITH DUE REGARD FOR THE POWERS RESERVED BY SCLHS. THE POWERS OF THE SFHC BOARD OF DIRECTORS INCLUDE NOMINATION OF BOARD MEMBERS FOR APPOINTMENT BY SCLHS. FOR APPOINTMENT BY SCLHS.
FORM 990, PART VI, SECTION A, LINE 11B
THE FORM 990 IS PROVIDED ELECTRONICALLY TO THE BOARD OF DIRECTORS AND APPROPRIATE SUB-COMMITTEES IN THE SAME FASHION AS ALL OTHER BOARD MATERIAL IS PROVIDED PRIOR TO THE FILING OF THE RETURN. THE RETURN IS REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS AND PRESENTED TO THE FULL BOARD OF DIRECTORS. THE FORM 990 IS REVIEWED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM CORPORATE OFFICE AS WELL AS AN INDEPENDENT ACCOUNTING FIRM BEFORE IT IS SENT TO THE ST. FRANCIS HEALTH CENTER BOARD OF DIRECTORS FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12(C)
ANNUALLY THE PRESIDENT SENDS A QUESTIONNAIRE AND COPIES OF THE "CONFLICTS OF INTEREST AND DISCLOSURE OF CERTAIN INTEREST" POLICY TO THE BOARD OF DIRECTORS, ALL ADMINISTRATIVE STAFF MEMBERS, AND EMPLOYEES HAVING RESPONSIBILITIES IN CONNECTION WITH PURCHASING GOODS AND SERVICES. THE PRESIDENT AND SECRETARY SHALL REVIEW EACH COMPLETED QUESTIONNAIRE (OTHER THAN THE QUESTIONNAIRE OF THE PRESIDENT) AND MAKE FURTHER INVESTIGATION OF POSSIBLE CONFLICTS OF INTEREST INVOLVING SUCH PERSONS AS THEY DEEM APPROPRIATE. THEY REPORT THE RESULTS OF SUCH REVIEW AND INVESTIGATION TO THE BOARD OF DIRECTORS. THE QUESTIONNAIRE COMPLETED ANNUALLY BY THE PRESIDENT SHALL BE REVIEWED AND INVESTIGATED BY THE COMMITTEE HAVING RESPONSIBILITY FOR SUCH REVIEW. ANY NEW BOARD MEMBER, ADMINISTRATIVE STAFF, OR EMPLOYEES AND VOLUNTEERS HAVING RESPONSIBILITES IN CONNECTION WITH PURCHAING GOODS AND SERVICES ARE REQUIRED TO SUBMIT A COMPLETED QUESTIONNAIRE FOR REVIEW CONCURRENT WITH THE ASSUMPTION OF THEIR RESPONSIBLITIES.
FORM 990, PART VI, LINE 19
ALL DOCUMENTS REQUIRED TO BE AVAILABLE TO THE PUBLIC ARE AVAILABLE UPON REQUEST FROM THE ST. FRANCIS HEALTH CENTER ADMINISTRATIVE OFFICE.
Form 990, Part VII and Schedule J, Part II, Part VI Lines 6 & 7
The Sisters of Charity of Leavenworth Health System, Inc. (SCLHS) is the sole corporate member of eleven hospitals and four clinics (Affiliates) in four states including St. Francis Health Center (St. Francis) in Topeka, Kansas. SCLHS and its Affiliates adhere to governance excellence standards including transparency and accountability. Jill Willen Kennelly is Vice President of Strategic Planning and Business Development for SCLHS. She also serves as a member of St. Francis' board. The compensation reflected is that of Ms. Willen Kennelly's position as an SCLHS executive and not as a member of St. Francis' board. In keeping with SCLHS' Core Value of Stewardship, no board member serving on SCLHS or Affiliate boards is compensated for that service. Michael Schrader served as CEO of St. Francis Health Center through August, 2009. His compensation from SCLHS is for his duties at St. Francis. Grant Wicklund compensation from SCLHS is for his services as interim CEO at St. Francis Health Center. Kimberly Brown is the Chief Financial Officer at St. Francis Health Center. Her compensation from SCLHS is for her duties in this position. Michael A. Dorsey is President & Chief Executive Officer of Providence Medical Center (Providence) in Kansas City, Kansas which is an SCLHS Affiliate. As a former key employee of St. Francis, this disclosure is required for 990 reporting purposes only. The compensation reflected is that of Mr. Dorsey's position as a Providence executive and is not related to St. Francis.
FORM 990, PART XI
RECONCILIATION OF NET ASSETS: UNREALIZED GAIN ON UNRESTRICTED INVESTMENTS 390,901 UNREALIZED GAIN ON BOARD DESIGNATED INVESTMENTS 15,659,374 ---------- SUBTOTAL 16,050,275 SYSTEM OFFICE INFORMATION TECH TRANSFER -1,716,172 ST. FRANCIS HLTH CNTR FOUNDATION EXPENSE TRANSFER - 487,199 ---------- SUBTOTAL -2,203,371 TOTAL 13,846,904 ==========