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
SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION
Employer identification number
45-0359620
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)
SISTERS OF MARY OF THE PRESENTATION MARYVALE PROVINCIAL CENTER
450281923
1
No
9,318
(2)
ST ALOISIUS HOSPITAL
450226729
3
No
442,644
(3)
ST MARGARET'S HOSPITAL
362167884
3
No
1,387,296
(4)
ST ANDREW'S HOSPITAL
450226426
3
No
346,440
(5)
PRESENTATION MEDICAL CENTER
450227391
3
No
381,227
(6)
SISTERS OF MARY OF THE PRESENTATION PRAIRIELAND HOME CARE
450391192
9
No
224,268
(7)
SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE
752999939
9
No
1,861,260
Total
4,652,453
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
SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION
Employer identification number
45-0359620
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE ORGANIZATION IS SISTERS OF MARY OF THE PRESENTATION MARYVALE PROVINCIAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7A
THE SOLE MEMBER, SISTERS OF MARY OF THE PRESENTATION MARYVALE PROVINCIAL CENTER, HAS THE POWER TO APPOINT AND REMOVE THE BOARD MEMBERS AND THE CHAIRPERSON OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOLLOWING RESERVED POWERS MAY ONLY BE EXERCISED BY AND BE EXCLUSIVELY VESTED IN THE MEMBER OF THE ORGANIZATION: 1. TO CHANGE THE PHILOSOPHY, OBJECTIVES, AND PURPOSES OF THE ORGANIZATION FOR WHICH IT WAS FORMED AND EXISTS; 2. TO AMEND THE ARTICLES OF INCORPORATION OR THE BYLAWS; 3. TO MERGE OR CONSOLIDATE WITH ANY OTHER CORPORATION; 4. TO RATIFY MANAGEMENT CONTRACTS APPROVED BY THE BOARD WITH HOSPITALS OTHER THAN THOSE SPONSORED BY THE SISTERS OF MARY OF THE PRESENTATION; 5. TO EFFECT THE DISSOLUTION OF ANY CORPORATION OF WHICH THIS ORGANIZATION IS A MEMBER; 6. TO EFFECT THE SALE, PURCHASE, LEASE, TRANSFER, EXCHANGE, OR ENCUMBRANCE OF ANY LAND, PROPERTY, OR ASSETS OWNED BY THE ORGANIZATION OR ANY CORPORATION OF WHICH THIS ORGANIZATION IS A MEMBER, OR IN WHICH SUCH CORPORATIONS HAVE OR WILL HAVE EQUITABLE OR LEGAL TITLE; 7. TO APPOINT AND REMOVE BOARD MEMBERS; 8. TO APPOINT AND REMOVE THE CHAIRPERSON OF THE BOARD; 9. TO RATIFY THE APPOINTMENTS OF LAY DIRECTORS TO THE BOARD MEMBERS OF ANY CORPORATION OF WHICH THIS ORGANIZATION IS A MEMBER; AND 10. TO APPROVE ANY OTHER MATTER THAT BY LAW OR THESE BYLAWS REQUIRES THE APPROVAL OF THE MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 8B
THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED. THE PRESIDENT/CEO AND VICE PRESIDENT OF FINANCE REVIEW THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C
EACH DIRECTOR MUST SUBMIT IN WRITING TO THE CHAIRPERSON OF THE BOARD AND THE PRESIDENT/CEO A LIST OF ALL BUSINESS OR OTHER ORGANIZATIONS OF WHICH THE INDIVIDUAL IS AN OFFICER, DIRECTOR, TRUSTEE, MEMBER, OWNER (EITHER AS A SOLE PROPRIETOR OR PARTNER), SHAREHOLDER WITH A 5% OR GREATER INTEREST IN ALL OUTSTANDING VOTING SHARES, EMPLOYEE OR AGENT, WITH WHICH THE ORGANIZATION HAS, OR MIGHT REASONABLY IN THE FUTURE ENTER INTO, A RELATIONSHIP OR A TRANSACTION IN WHICH THE DIRECTOR WOULD HAVE CONFLICTING INTERESTS. EACH WRITTEN STATEMENT IS RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR. THE CHAIRPERSON OF THE BOARD REVIEWS THE STATEMENTS OF THE DIRECTORS AND THE VICE CHAIRPERSON OF THE BOARD REVIEWS THE STATEMENT FILED BY THE CHAIRPERSON. WHEN A CONFLICT ARISES THE AFFECTED DIRECTOR MAKES KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS, WILL WITHDRAW FROM THE MEETING FOR AS LONG AS THE MATTER CONTINUES UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO A VOTE, THE AFFECTED DIRECTOR WILL NOT VOTE ON IT. IN THE EVENT THE DIRECTOR DOES NOT WITHDRAW VOLUNTARILY, THE CHAIRPERSON OF THE BOARD AS AUTHORITY TO REQUIRE THE DIRECTOR TO REMOVE HIMSELF/HERSELF FROM THE ROOM DURING BOTH THE DISCUSSION AND VOTE ON THE MATTER. IN THE EVENT THE CONFLICT OF INTEREST AFFECTS THE CHAIRPERSON, THE VICE CHAIRPERSON HAS AUTHORITY TO REQUIRE THE CHAIRPERSON REMOVE HIMSELF/HERSELF IN THE SAME MATTER. IF THE MATTER IS THE ITEM OF BUSINESS FOR WHICH A SPECIAL MEETING OF THE BOARD WAS CALLED, THE AFFECTED DIRECTOR WILL NOT BE COUNTED TO ESTABLISH A QUORUM, AND HE/SHE WILL NOT PARTICIPATE IN THE DELIBERATIONS OR VOTE ON IT.
FORM 990, PART VI, SECTION B, LINE 15
THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND KEY EMPLOYEES. THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION BOARD OF TRUSTEES APPROVES ALL COMPENSATION BASED ON COMPARABLE DATA AND DOCUMENTS THEIR DECISION IN THE MEETING MINUTES. THE COMPENSATION PROCESS IS DESIGNED TO ENSURE COMPENSATION AND BENEFITS ARE REASONABLE AND THAT INDIVIDUAL PERFORMANCE IS DRIVING ACHIEVEMENT OF THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION MISSION. THE ORGANIZATION PROVIDES MARKET COMPETITIVE SALARIES AND INCENTIVES THAT RECOGNIZE EXCEPTIONAL PERFORMANCE AND SUPPORT OF THE SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION'S MISSION GOALS.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FINANCIAL INFORMATION IS AVAILABLE THROUGH THE PUBLIC DISCLOSURE COPY OF THE 990.
FORM 990, PART VII, SECTION A:
COMPENSATION FOR THE RELATED ENTITIES IS PAID BY SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. THE TOP FIVE COMPENSATED INDIVIDUALS LISTED IN THIS SECTION ARE OFFICERS OF THEIR RESPECTIVE LOCATIONS. THE HOURS WORKED, LISTED BELOW, ARE FOR SERVICES PERFORMED FOR THESE LOCATIONS. TIMOTHY MUNTZ 40 HOURS FOR PRESIDENT/CEO SERVICES AT ST. MARGARET'S HOSPITAL KIMBER WRAALSTAD 40 HOURS FOR CEO OF PRESENTATION MEDICAL CENTER KIM SANTMAN 40 HOURS FOR VICE PRESIDENT OF FINANCE AT ST. MARGARET'S HOSPITAL JASON DOTSON 40 HOURS FOR VICE PRESIDENT OF CLINICS AT ST. MARGARET'S HOSPITAL CRAIG CHRISTIANSON 40 HOURS FOR CEO OF SHEYENNE CARE CENTER WHICH IS PART OF SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE
FORM 990, PART VII, SECTION A:
IN ADDITION TO PROVIDING SERVICES TO SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION, AARON ALTON, PRESIDENT/CEO, AND GARY BAKKE, VICE PRESIDENT OF FINANCE, PERFORM SERVICES FOR THE RELATED HOSPITALS, HOME HEALTH AGENCY, AND FIVE RELATED LONG-TERM CARE FACILITIES. BOTH AARON AND GARY DEDICATE A MINIMUM OF 40 HOURS PER WEEK TO THE RELATED ORGANIZATIONS. SISTER SUZANNE STAHL DEVOTES TIME TO ALL THE RELATED ORGANIZATIONS AS A NON-VOTING RECORDING SECRETARY. THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. SISTERS OF MARY OF THE PRESENTATION LONG TERM CARE SR. MARGARET ROSE PFEIFER .5 HOURS PER WEEK SISTERS OF MARY OF THE PRESENTATION PRAIRIELAND HOME HEALTH AGENCY SR. MARGARET ROSE PFEIFER .3 HOURS PER WEEK ST. ALOISIUS HOSPITAL SR. MARGARET ROSE PFEIFER .5 HOURS PER WEEK PRESENTATION MEDICAL CENTER SR. MARGARET ROSE PFEIFER .5 HOURS PER WEEK ST. ANDREW'S HOSPITAL SR. MARGARET ROSE PFEIFER .3 HOURS PER WEEK SMP ENTERPRISES SR. MARGARET ROSE PFEIFER .3 HOURS PER WEEK SISTERS OF MARY OF THE PRESENTATION MARYVALE PROVINCIAL CENTER SR. CAROL JEAN KUNTZ 40 HOURS PER WEEK SR. SUZANNE STAHL 40 HOURS PER WEEK SR. MARGARET ROSE PFEIFER 40 HOURS PER WEEK SR. ROSE THERESE SEVIGNY 40 HOURS PER WEEK
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -81,632.
FORM 990, SCHEDULE A, PART I, LINE 11H:
SISTERS OF MARY OF THE PRESENTATION IS SPECIFIED BY NAME IN THE GOVERNING DOCUMENTS OF SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION. ALL OTHER SUPPORTED ORGANIZATIONS ARE DESIGNATED BY CLASS IN THE GOVERNING DOCUMENTS OF SISTERS OF MARY OF THE PRESENTATION HEALTH CORPORATION.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.