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
MEMORIAL HEALTH PARTNERS FOUNDATION INC
Employer identification number
03-0417049
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.") .
0
0
162,500
162,700
4,778,236
5,103,436
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......
36,224,689
40,528,277
44,720,976
53,237,758
59,240,058
233,951,758
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
36,224,689
40,528,277
44,883,476
53,400,458
64,018,294
239,055,194
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public Support (Subtract line 7c from line 6.)
239,055,194
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...
36,224,689
40,528,277
44,883,476
53,400,458
64,018,294
239,055,194
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
78,761
52,780
6,289
2,530
690
141,050
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
78,761
52,780
6,289
2,530
690
141,050
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
0
0
4,522
6,735
11,257
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
0
0
8,672
0
0
8,672
13
Total support (Add lines 9, 10c, 11 and 12.).
36,303,450
40,581,057
44,898,437
53,407,510
64,025,719
239,216,173
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
99.930 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.920 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.060 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.080 %
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
OTHER INCOME, SCHEDULE A, PART III, SECTION B, LINE 12, MISCELLANEOUS INCOME: 2006 - $0 2007 - $0 2008 - $8,672 2009 - $0 2010 - $0,
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000128
Software Version:
v2010.1.0
-
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
MEMORIAL HEALTH PARTNERS FOUNDATION INC
Employer identification number
03-0417049
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
I. INTRODUCTION MEMORIAL HEALTH PARTNERS FOUNDATION, INC. (MHPF) IS A TENNESSEE NONPROFIT CORPORATION THAT WAS FORMED ON MARCH 21, 2002, TO PROVIDE MEDICAL SERVICES IN CHATTANOOGA, TENNESSEE AND ITS SURROUNDING COMMUNITY. MHPF OWNS AND OPERATES PHYSICIAN CLINICS AND RELATED FACILITIES IN THE AREA AND ENGAGES IN ACTIVITIES DESIGNED TO PROMOTE THE HEALTH CARE NEEDS OF THE COMMUNITY, IN PARTICULAR THE PROVISION OF HEALTH CARE SERVICES BY PHYSICIANS AND OTHER HEALTH CARE PROFESSIONALS. MHPF CURRENTLY PROVIDES SERVICES AT 26 CLINIC LOCATIONS THROUGH 71 PHYSICIAN EMPLOYEES AND 15 MID-LEVEL PROVIDER EMPLOYEES. MHPF ALSO PROVIDES HOSPITALIST SERVICES AT MEMORIAL HEALTH CARE SYSTEM CAMPUSES THROUGH 32 PHYSICIAN EMPLOYEES AND 3 MID-LEVEL PROVIDER EMPLOYEES. MEDICAL CARE IS PROVIDED TO ALL PERSONS IN THE COMMUNITY, REGARDLESS OF THEIR ABILITY TO PAY. MHPF'S SOLE CORPORATE MEMBER IS MEMORIAL HEALTH CARE SYSTEM, INC. (MHCS), A TENNESSEE NONPROFIT CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MHPF AND MHCS ARE PART OF A NATIONWIDE SYSTEM OF NONPROFIT, TAX-EXEMPT HEALTH CARE PROVIDERS OF WHICH CATHOLIC HEALTH INITIATIVES, INC. (CHI), A COLORADO NONPROFIT CORPORATION WHICH IS ALSO EXEMPT FROM FEDERAL TAX AS AN ORGANIZATION DESCRIBED UNDER SECTION 501(C)(3), SERVES AS THE SOLE CORPORATE MEMBER. AS A PART OF THE CHI SYSTEM, MHPF AND MHCS OPERATE IN CONFORMITY WITH THE MISSION OF CHI, WHICH AMONG OTHER THINGS OBLIGATES MHPF AND MHCS TO OPERATE IN WAYS THAT "NURTURE THE HEALING MINISTRY OF THE CHURCH, BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY," AND THAT "EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE IN THE CREATION OF HEALTHIER COMMUNITIES." MHPF IS DEDICATED TO CHRISTIAN VALUES AND IS ABLE TO INCORPORATE EFFICIENT PRACTICES TO ENSURE CONTINUATION OF ITS MISSION INTO THE FUTURE. MHPF PARTICIPATES IN TNCARE AND MEDICARE, AND HAS AN ACTIVE CHARITY CARE PROGRAM. MHPF WAS GRANTED TAX EXEMPT STATUS ON MARCH 24, 2002 AS A 509(A)(2) ENTITY. II. COMMUNITY BENEFIT APPROACH MHPF'S 26 CLINICS ARE DISPERSED IN FOUR COUNTIES IN SOUTHEAST TENNESSEE AND NORTHEAST GEORGIA. SINCE ITS FORMATION IN 2002, MHPF'S PRIMARY FOCUS HAS BEEN THE PROVISION OF HEALTH CARE SERVICES AND THE PROMOTION OF A HEALTHY COMMUNITY. MHPF UNDERSTANDS THE NEEDS IN MEDICALLY UNDERSERVED AREAS WITHIN CHATTANOOGA AND OPERATES TWO CLINICS IN THOSE AREAS IN ORDER TO PROVIDE CARE TO THE UNDERSERVED. MHPF AS A RESULT COMMITS SUBSTANTIAL RESOURCES TO SPONSOR A BROAD RANGE OF SERVICES TO BOTH THE POOR AS WELL AS THE BROADER COMMUNITY. BENEFITS FOR THE POOR INCLUDE THE COST OF PROVIDING SERVICES TO PERSONS WHO CANNOT AFFORD HEALTH CARE DUE TO INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED, AND INCLUDE TRADITIONAL CHARITY CARE, UNPAID COSTS OF MEDICAID, AND OTHER UNPAID COSTS OF CLINICS. BENEFITS PROVIDED TO THE BROADER COMMUNITY ALSO INCLUDE THE COSTS OF PROVIDING SERVICES TO OTHER POPULATIONS WHO MAY NOT QUALIFY AS POOR BUT MAY NEED SPECIAL SERVICES AND SUPPORT. BENEFITS TO THE BROADER COMMUNITY INCLUDE THE UNPAID COSTS OF MEDICARE PROGRAMS FOR SENIORS. IN FISCAL YEAR 2011, MEMORIAL HEALTH PARTNERS FOUNDATION PROVIDED COMMUNITY BENEFITS AND SERVICES THROUGH APPROXIMATELY 196,500 PATIENT ENCOUNTERS AT A TOTAL COST OF $30,555,000. DONATIONS, GRANTS, AND OTHER RECEIPTS TOTALING $17,139,000 WERE AVAILABLE AS DIRECT OFFSETS TO THESE COSTS. THE MAJOR COMPONENTS OF THESE COMMUNITY SERVICES ARE AS FOLLOWS: COMMUNITY BENEFITS FOR THE POOR: $707,000 COST OF CHARITY CARE PROVIDED (APPROXIMATELY 11,500 PEOPLE SERVED) $557,000 UNREIMBURSED COST OF PUBLIC PROGRAMS (APPROXIMATELY 11,000 PEOPLE SERVED) $89,000 NON-BILLED SERVICES FOR THE POOR (APPROXIMATELY 22,500 PEOPLE SERVED) ------------- $1,353,000 TOTAL COST OF COMMUNITY BENEFITS FOR THE POOR (APPROXIMATELY 22,500 PEOPLE SERVED) BENEFITS FOR THE BROADER COMMUNITY: $12,063,000 UNPAID COSTS OF MEDICARE (APPROXIMATELY 174,000 PEOPLE SERVED) ------------- $13,416,000 TOTAL COST OF COMMUNITY BENEFITS INCLUDING THE UNPAID COST OF MEDICARE (APPROXIMATELY 196,500 PEOPLE SERVED) III. UNCOMPENSATED CARE CHARITY CARE IS THE COST OF CARE OF UNINSURED OR UNDER-INSURED, LOW-INCOME PATIENTS WHO ARE NOT EXPECTED TO PAY ALL OF A BILL, OR WHO ARE ABLE TO PAY ONLY A PORTION USING AN INCOME-RELATED SCALE. THOSE RECEIVING CHARITY CARE ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS SUCH AS TNCARE. MHPF HAS A CHARITY CARE POLICY, WHICH ASSURES THAT ALL PERSONS RECEIVE MEDICALLY NECESSARY, BASIC PHYSICIAN CARE AND SERVICES REGARDLESS OF THEIR ABILITY TO PAY. MHPF PROVIDES A SIGNIFICANT LEVEL OF CHARITY CARE EACH YEAR. IN FY 2011, THE COST OF CHARITY CARE WAS $707,476. ADDITIONALLY, MHPF PROVIDED UNREIMBURSED COSTS IN THE AMOUNT OF $557,145 FOR PATIENTS WHO QUALIFIED FOR THE TNCARE PROGRAM. IV. COMMUNITY OUTREACH FOR THE POOR PRIMARY CARE HEALTH CLINICS: SEVERAL AREAS OF CHATTANOOGA DO NOT HAVE CONVENIENT ACCESS TO PRIMARY HEALTHCARE SERVICES. TO ANSWER THE NEED FOR MORE CONVENIENT HEALTHCARE, MHPF HAS TWO COMMUNITY BASED HEALTH CLINICS. THESE CLINICS OPERATE IN FEDERALLY DESIGNATED HEALTHCARE SHORTAGE AREAS - BOTH ARE IN MEDICALLY UNDERSERVED AREA/POPULATION (MUA/P). EACH CLINIC IS STAFFED WITH NURSE PRACTITIONERS WORKING IN COLLABORATION WITH A PHYSICIAN MEDICAL DIRECTOR WHO ADDRESS PATIENT CARE "HOLISTICALLY" IN A MANNER WHICH ACKNOWLEDGES THE RELATIONSHIPS OF PHYSICAL, MENTAL AND SPIRITUAL HEALTH. THE TWO CLINICS PROVIDE CARE FOR EVERYONE IN THE FAMILY REGARDLESS OF THEIR ABILITY TO PAY. UNREIMBURSED COSTS (IN ADDITION TO COSTS REPORTED IN THE COMMUNITY BENEFITS TABLE ABOVE) IN FY 2011 TOTALED $140,000 FOR THE PRIMARY CARE CLINICS. V. UNBILLED SERVICES FOR THE POOR PHARMACY ASSISTANCE: THE COMMUNITY BASED HEALTH CLINICS PROVIDE PHARMACY ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS IN THE FORM OF A PHARMACY ASSISTANCE COORDINATOR. THE COORDINATOR APPLIES FOR FINANCIAL AID DIRECTLY WITH PHARMACEUTICAL COMPANIES. WITHOUT THIS ASSISTANCE, THE UNINSURED AND UNDERINSURED PATIENTS WHO ARE CARED FOR IN THE CLINICS MAY NOT HAVE ACCESS TO THE MEDICINES THEY NEED. FOR FISCAL YEAR 2011, MHPF'S COST OF PROVIDING THIS SERVICE WAS $54,088. ACCESS TO SPECIALTY CARE: THE COMMUNITY BASED HEALTH CLINICS ALSO COORDINATE ACCESS TO SPECIALTY CARE VIA COORDINATION WITH PROJECT ACCESS, A LOCAL NETWORK OF SPECIALISTS WHO HAVE AGREED TO PROVIDE CARE TO THE UNINSURED AND UNDERINSURED. WITHOUT THIS SERVICE THE CLINICS' UNINSURED AND UNDERINSURED PATIENTS MAY NOT BE ABLE TO ACCESS THE SPECIALTY CARE THEY NEED. FOR FISCAL YEAR 2011, MHPF'S COST OF PROVIDING THIS SERVICE WAS $34,475. V. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY UNPAID COSTS OF MEDICARE: MHPF HAS A VERY LARGE MEDICARE POPULATION REPRESENTING ABOUT 42% OF THE TOTAL POPULATION OF PATIENTS SEEN IN FY 2011. MHPF INCURRED $12,063,000 IN UNREIMBURSED COSTS FOR ITS MEDICARE PATIENTS DURING FY 2011. MHPF'S UNREIMBURSED COSTS FROM THE MEDICARE PROGRAM ARE COMPUTED IN A MANNER CONSISTENT WITH A STANDARDIZED APPROACH DEVELOPED BY CATHOLIC HEALTH INITIATIVES FOR REPORTING AND BUDGETING BENEFITS PROVIDED TO THE COMMUNITY.
DR. GARY MEREDITH, DR. VIRGINIA RODGERS, AND DR. JOSH SMITH - BUSINESS RELATIONSHIP
Delegation of management duties
Form 990, Part VI, Section A, Line 3
MEMORIAL HEALTH PARTNERS FOUNDATION (MHPF) HAS A MANAGEMENT AGREEMENT WITH MOUNTAIN MANAGEMENT SERVICES WHEREBY MOUNTAIN MANAGEMENT PROVIDES MANAGEMENT, BILLING/COLLECTIONS, AND OTHER NECESSARY SERVICES TO OPERATE MHPF'S MEDICAL CLINICS.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE SOLE MEMBER OF THE ORGANIZATION IS MEMORIAL HEALTH CARE SYSTEM, INC., A TENNESSEE NONPROFIT CORPORATION.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
THE ORGANIZATION'S SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE ORGANIZATION'S CORPORATE MEMBER IS MEMORIAL HEALTH CARE SYSTEM, INC. ("MHCS"). PURSUANT TO THE ORGANIZATION'S BYLAWS, BOTH MHCS AND CATHOLIC HEALTH INITIATIVES ("CHI") (MHCS' SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE MHCS BOARD: - APPROVE MEMBERS OF THE MHP FOUNDATION BOARD - AMENDMENT OF THE CORPORATE DOCUMENTS OF THE MHP FOUNDATION - APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE MHP FOUNDATION - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE MHP FOUNDATION THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: - SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE MHP FOUNDATION - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE MHP FOUNDATION - APPROVAL OF ISSUANCE OF DEBT BY MHP FOUNDATION - APPROVAL OF PARTICIPATION OF MHP FOUNDATION IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY MHP FOUNDATION - APPROVAL OF A MERGER INVOLVING THE MHP FOUNDATION - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE MHP FOUNDATION - TO REQUIRE THE TRANSFER OF ASSETS BY THE MHP FOUNDATION TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS ALSO PURSUANT TO THE ORGANIZATION'S BYLAWS, MHCS OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11a
ONCE THE RETURN IS PREPARED BY THE CHI TAX DEPARTMENT, THE RETURN IS REVIEWED BY THE MHP FOUNDATION CEO, MHP FOUNDATION CFO, AND THE MHCS CFO. COPIES OF THE FINAL RETURN ARE THEN PROVIDED TO THE MHP FOUNDATION BOARD MEMBERS. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
MHP FOUNDATION (MHPF) HAS A POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. ACCORDING TO THE POLICY, ALL BOARD MEMBERS, HIGHEST COMPENSATED EMPLOYEES, AND EMPLOYEES AT THE LEVEL OF DIRECTOR OR ABOVE ARE REQUIRED TO SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY; THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE (BOARD MEMBERS) OR EMPLOYEE (DIRECTOR AND ABOVE) FILES. ALL BOARD MEMBERS ARE ALSO REQUESTED TO DECLARE ANY NEW POTENTIAL CONFLICTS OF INTEREST THAT MAY HAVE ARISEN AT EACH MONTHLY BOARD OF DIRECTORS MEETING AND AT COMMITTEE MEETINGS OF THE BOARD (OPERATIONS COMMITTEE, COMPENSATION COMMITTEE, QUALITY COMMITTEE). IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, AFFECTED BOARD MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING REGARDING THOSE ITEMS. SUSPECTED CONFLICTS OF INTEREST ARE DISCLOSED AND REVIEWED BY THE CFO AND CEO, AS WELL AS THE CORPORATE RESPONSIBILITY COMMITTEE OF MHCS. ANY NON-DISCLOSED CONFLICTS THAT ARE LATER DISCOVERED ARE INVESTIGATED WITH APPROPRIATE DISCIPLINARY ACTION BY THE CEO.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
COMPENSATION FOR THE ORGANIZATION'S PRESIDENT IS PAID BY MEMORIAL HEALTH CARE SYSTEM (MHCS), A RELATED TAX-EXEMPT ORGANIZATION. MHCS RELIES ON MARKET DATA PROVIDED BY THE HUMAN RESOURCES COMMITTEE. THE REVIEW IS PERFORMED TO ENSURE THAT THE PRESIDENT'S SALARY IS WITHIN COMPARABLE MARKET RANGES FOR THAT POSITION. THE RESULTS OF THE REVIEW ARE PRESENTED TO THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE PRESIDENT'S COMPENSATION REVIEW LAST TOOK PLACE WHEN HE WAS HIRED DURING FISCAL YEAR 2011.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
THE BOARD SECRETARY'S COMPENSATION IS PAID BY MEMORIAL HEALTH CARE SYSTEM (MHCS), A RELATED NONPROFIT ORGANIZATION, FOR HER SERVICES AS STRATEGIC INTEGRATION OFFICER. ON AN ANNUAL BASIS MHCS ENGAGES AN EXTERNAL CONSULTANT TO REVIEW THE COMPENSATION OF ITS EXECUTIVES. THE REVIEW IS PERFORMED TO ENSURE THAT EXECUTIVE SALARIES ARE WITHIN COMPARABLE MARKET RANGES FOR THAT POSITION. THE RESULTS OF THE REVIEW ARE PRESENTED TO THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS OF MHCS FOR APPROVAL. HISTORICALLY, PHYSICIAN COMPENSATION ARRANGEMENTS HAVE BEEN REVIEWED FOR REASONABLENESS WHEN THE CONTRACT IS UP FOR RENEWAL. UNDER A NEW POLICY, ALL PHYSICIAN COMPENSATION ARRANGEMENTS ARE REVIEWED AT LEAST ONCE EVERY THREE YEARS TO ENSURE REASONABLENESS OF COMPENSATION IN LIGHT OF MARKET COMPARABILITY DATA. PHYSICIAN OFFICER COMPENSATION WAS PAID PURSUANT TO CONTRACTUAL AGREEMENTS THAT WERE IN PLACE DURING THE YEAR; AS SUCH, THESE AGREEMENTS UNDERWENT THEIR REQUIRED THREE YEAR REVIEW OF REASONABLENESS OF COMPENSATION DURING MAY 2011.
Public Disclosure
Form 990, Part VI, Section C, Line 19
THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT, AND ARE ALSO AVAILABLE FROM THE TENNESSEE SECRETARY OF STATE. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG.
DOCUMENT RETENTION AND DESTRUCTION POLICY
FORM 990, PART VI, SECTION B, LINE 14
MHP FOUNDATION (MHPF) FOLLOWS THE DOCUMENT RETENTION AND DESTRUCTION POLICY OF MEMORIAL HEALTH CARE SYSTEM, MHPF'S SOLE CORPORATE MEMBER. HOWEVER, THIS POLICY HAS NOT BEEN FORMALLY ADOPTED MY MHPF'S BOARD OF DIRECTORS.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A, LINE 1A
COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOUR-PER-WEEK EMPLOYEES. COMPENSATION OF HIGHEST COMPENSATED EMPLOYEES (PHYSICIANS) REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 40 HOUR-PER-WEEK EMPLOYEES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.