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
CHRIST HOSPITAL
Employer identification number
22-0820545
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 E(Form 990 or 990-EZ) Department of the TreasuryInternal Revenue Service
SchoolsComplete if the organization answered "Yes" to Form 990, Part IV, line 13, or Form 990-EZ, Part VI, line 48. Attach to Form 990 or Form 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHRIST HOSPITAL
Employer identification number
22-0820545
Part I
YES
NO
1
Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body?
......................
1
Yes
2
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its
brochures, catalogues, and other written communications with the public dealing with student admissions,
programs, and scholarships?
......................................
2
Yes
3
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way
that makes the policy known to all parts of the general community it serves? If "Yes," please describe. If "No,"
please explain. If you need more space use Part II.
.............................
3
Yes
4
Does the organization maintain the following?
a
Records indicating the racial composition of the student body, faculty, and administrative staff?
..........
4a
Yes
b
Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory
Other extracurricular activities?
.....................................
5h
No
If you answered "Yes" to any of the above, please explain. If you need more space, use Part II.
6a
Does the organization receive any financial aid or assistance from a governmental agency?
............
6a
Yes
b
Has the organization's right to such aid ever been revoked or suspended?
...................
6b
No
If you answered "Yes" to either line 6a or line 6b, explain on Part II.
7
Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If "No," explain on Part II.
7
Yes
Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50085D
Schedule E (Form 990 or 990-EZ) 2010
Schedule E (Form 990 or 990EZ) 2010
Page 2
Part II
Supplemental Information
Complete this part to provide the explanations required by Part I, lines 3, 4d, 5h, 6b, and 7, as applicable. Also complete this part to provide any other additional information (see instructions).
Identifier
Return Reference
Explanation
Schedule E (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
CHRIST HOSPITAL
Employer identification number
22-0820545
Identifier
Return Reference
Explanation
NEW PROGRAM SERVICES
FORM 990, PART III, LINE 2
CHRIST HOSPITAL FORMED A PARTNERSHIP WITH GOLDMAN SACHS IN 2010 TO HOST A COMMUNITY HEALTH FAIR, WHICH WAS HELD AT CHRIST HOSPITAL ON JUNE 6, 2011. PREPARATIONS FOR THE EVENT COMMENCED IN THE FALL OF 2010. CHRIST HOSPITAL ADMINISTRATIVE STAFF CONDUCTED A SERIES OF MEETINGS WITH KEY REPRESENTATIVES FROM GOLDMAN SACHS TO COORDINATE AND PLAN FOR THE EVENT. SEVERAL DEPARTMENTS FROM THE HOSPITAL PARTICIPATED IN THE FAIR, INCLUDING REPRESENTATIVES FROM THE EMERGENCY DEPARTMENT; CARDIOVASCULAR; ENDOSCOPY; PEDIATRICS; BEHAVIORAL HEALTH, RADIOGRAPHY, ONCOLOGY; LABOR AND DELIVERY; PHYSICAL THERAPY; RESPIRATORY; THE SLEEP CENTER; PASTORAL CARE; THE CHRIST HOSPITAL SCHOOL OF NURSING; AND THE CHRIST HOSPITAL SCHOOL OF RADIOGRAPHY. FAIR VISITORS RECEIVED BROCHURES AND INFORMATION FROM THE VARIOUS DEPARTMENTS INCLUDING AN OPPORTUNITY TO COMPLETE AN ADVANCED DIRECTIVE FORM PROVIDED BY THE PASTORAL CARE DEPARTMENT. IN ADDITION TO BLOOD PRESSURE SCREENINGS, FAIR VISITORS WERE GIVEN THE OPPORTUNITY TO RECEIVE BODY MASS INDEX MEASUREMENTS AND GLUCOSE SCREENINGS. THOSE PEOPLE THAT WERE IDENTIFIED WITH A HIGH LEVEL OF BLOOD SUGAR WERE GIVEN FREE HOME GLUCOSE MONITORS AND A PACKAGE OF TEST STRIPS. TOURS OF THE HOSPITAL WERE GIVEN TO FAIR ATTENDEES. DEPARTMENTS THAT WERE INCLUDED ON THE TOUR WERE THE LABOR AND DELIVERY DEPARTMENT; THE SLEEP CENTER; THE CARDIOVASCULAR DEPARTMENT; AND THE ONCOLOGY DEPARTMENT. A 20' X 30' TENT WAS PROVIDED WHERE VOLUNTEERS FROM GOLDMAN SACHS SUPERVISED ACTIVITIES FOR THE CHILDREN THAT ATTENDED THE HEALTH FAIR. THE DIETARY DEPARTMENT PROVIDED HEALTHY SNACKS TO VISITORS. THE HEALTH FAIR HOSTED OVER 150 PEOPLE FROM THE LOCAL COMMUNITY AND ALL SERVICES PROVIDED BY HEALTHCARE PERSONNEL, SNACKS, AND GIVE-AWAYS WERE PROVIDED FREE-OF-CHARGE.
FORM 990, PART VI, SECTION A, LINE 2
JOSEPH A. PANEPINTO ESQ., VICE-CHAIRMAN, HAS A BUSINESS RELATIONSHIP WITH CHARLES J. HARRINGTON, VICE-CHAIRMAN. IN ADDITION, JOSEPH A. PANEPINTO ESQ., VICE-CHAIRMAN, HAS A BUSINESS RELATIONSHIP WITH JAMES N. LINDEMON, TRUSTEE.
FORM 990, PART VI, SECTION A, LINE 6
CANTERBURY HEALTH SERVICES, INC. (CANTERBURY) A 501(C)(3) ORGANIZATION IS THE SOLE MEMBER OF CHRIST HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A
CANTERBURY HEALTH SERVICES, INC. HAS THE AUTHORITY TO ELECT MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
DATA IS PREPARED AND ACCUMULATED BY THE FINANCE STAFF OF THE HOSPITAL FOR THE COMPLETION OF FORM 990. THIS DATA IS PROVIDED TO A FIRM THAT ASSISTS AND ADVISES ON THE COMPLETION OF THE RETURN. A DRAFT FORM 990 IS REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER OF THE HOSPITAL. THE DRAFT FORM 990 IS FORWARDED AND REVIEWED BY THE AUDIT COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 12C
HOSPITAL POLICY REQUIRES THAT BOARD MEMBERS AND MANAGEMENT COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS. QUESTIONNAIRES ARE RETURNED TO THE HOSPITAL'S COMPLIANCE OFFICER WHO REVIEWS ALL REPORTED CONFLICTS. THE COMPLIANCE OFFICER REPORTS DIRECTLY TO THE BOARD OF TRUSTEES. REPORTED CONFLICTS ARE REVIEWED BY THE COMPLIANCE OFFICER AND THE AUDIT COMMITTEE. THE AUDIT COMMITTEE BRINGS TO THE FULL BOARD ANY UNRESOLVED CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15
THE COMPENSATION REVIEW FOR SENIOR MANAGEMENT IS PRESENTED BY THE CHIEF EXECUTIVE OFFICER TO THE COMPENSATION COMMITTEE. THE PROCESS FOR REVIEW OF SENIOR MANAGEMENT COMPENSATION IS SIMILAR TO THAT PERFORMED FOR THE CHIEF EXECUTIVE OFFICER.
FORM 990, PART VI, SECTION C, LINE 19
THE HOSPITAL HAS NOT RECEIVED REQUESTS IN THE PAST FOR ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY. FINANCIAL STATEMENTS HAVE BEEN MADE AVAILABLE TO THE PUBLIC IN THE PAST GENERALLY IN CONJUNCTION WITH A REQUEST FOR THE FORM 990. THE HOSPITAL WILL UPON WRITTEN REQUEST PROVIDE THESE ADDITIONAL DOCUMENTS TO THE EXTENT ALLOWABLE OR REQUIRED BY LAW.
FORM 990, PART VII
RAASHAN C. WILLIAMS,. M.D., IS A DIRECTOR OF CARDIC CATH AND OPERATES A PRIVATE CARDIOLOGY PRACTICE. ANGEL LAZO JR., M.D., MED DIR INPT CHARITY, WAS ALSO AN INTERM CHIEF OF MEDICINE.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -72,448. CHANGE IN MINIMUM PENSION LIABILITY -15,458,685. TOTAL TO FORM 990, PART XI, LINE 5: -15,531,133.
FORM 990, PART XI, LINE 2C
FINANCE COMMITTEE MEETS ONCE PER MONTH AND AUDIT COMMITTEE MEETS EACH QUARTER. ANNUALLY, DISCUSSIONS TAKE PLACE REGARDING THE QUALITY OF SERVICE AND RELATED COSTS OF THE INDEPENDENT ACCOUNTANT. WHEN NECESSARY, A CHANGE IN THE SELECTION IS MADE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART IX
CANTERBURY MEDICAL ASSOCIATES HAD EXPENSES OF $1,954,715 WHICH ARE INCLUDED IN THE FUNCTIONAL EXPENSES.
FORM 990, PART VI, SECTION A, QUESTIONS 1A&B:
THE ORGANIZATION SELECTS ITS BOARD MEMBERS IN APRIL OF EACH YEAR. THEREFORE, FORM 990, PART VII INCLUDES INDIVIDUALS THAT WERE NO LONGER VOTING MEMBERS AS OF THE ORGANIZATION'S TAX YEAR END. PART VI, SECTION A, QUESTIONS 1A&B REPORTS VOTING MEMBERS AS OF THE END OF THE ORGANIZATION'S TAX YEAR, AS REQUIRED BY IRS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.