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
FRANCISCAN MEDICAL GROUP
Employer identification number
91-1939739
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.") .
14,695,957
20,006,597
32,926,864
45,248,796
51,321,839
164,200,053
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......
54,157,251
67,329,518
84,099,070
103,707,245
118,713,876
428,006,960
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
1,423,851
2,281,932
3,705,783
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.
68,853,208
87,336,115
117,025,934
150,379,892
172,317,647
595,912,796
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
85,000
28,277
113,277
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..
85,000
28,277
113,277
8
Public Support (Subtract line 7c from line 6.)
595,799,519
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...
68,853,208
87,336,115
117,025,934
150,379,892
172,317,647
595,912,796
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
48,833
56,047
26,531
6,412
10,150
147,973
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
48,833
56,047
26,531
6,412
10,150
147,973
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.).
68,902,041
87,392,162
117,052,465
150,386,304
172,327,797
596,060,769
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
99.956 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.946 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.025 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.036 %
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
FRANCISCAN MEDICAL GROUP
Employer identification number
91-1939739
Identifier
Return Reference
Explanation
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, Q. 4A
i. introduction A. Market Based Organization Mission and Vision Franciscan Medical Group was founded in April 1999 to provide community based health care services. Since its inception, Franciscan Medical Group has focused on providing quality health care to all members of their community regardless of ability to pay for services. Community service has always been at the core of our activity. B. Community Benefit Approach Franciscan Medical Group clinics provide services across a large geography of south Puget Sound in Washington State, serving a diverse population in our service area. Franciscan Medical Group provides services to patients regardless of race, creed, sex, national origin, handicap or ability to pay. The programs and services described throughout this document not only serve the community but also reduce the burden on governmental programs, i.e. Medicare and Medicaid. Without the charity care provided by Franciscan Medical Group clinics, the community charity care cases would fall upon the more expensive emergency rooms in local hospitals, including those operated by local government. Franciscan Medical Group has over 216 providers located in 57 clinics with annual patient visits of 883,343. II. Quantitative Description of Community Benefit: Uncompensated Care As described below, Franciscan Medical Group provided a significant level of charity care services to those with limited or an inability to pay. To the extent Medicare and Medicaid reimbursement is below cost, Franciscan Medical Group recognizes these amounts as the uncompensated cost of providing care. As mentioned above, Franciscan Medical Group provides services to patients regardless of race, creed, sex, national origin, handicap, or ability to pay. Most physician groups in the State of Washington have either partially or fully closed their practices to new Medicare and Medicaid patients as the reimbursement for these programs has increasingly fallen short of the cost of providing that care. Although reimbursement for services rendered is critical to the operation and stability of Franciscan Medical Group, not all individuals possess the ability to purchase essential medical services and our mission is to serve the community by providing health care services and health care education. Therefore, in keeping with Franciscan Medical Group's commitment to serve all members of its community, we provide care to persons covered by governmental programs - although the cost of providing that care exceeds governmental program reimbursement. For the fiscal year ending June 30, 2011, the cost of uncompensated Medicare care amounted to $20.5 million; for Medicaid it amounted to $ 12.5 million; Charity care totaled $ 1.0 million for the year. III. Qualitative Description of Community Benefit A. Community Outreach for the Poor and the Broader Community Activities offered include wellness programs, community education programs, special programs for terminally ill patients, and a broad variety of community support activities. Franciscan Medical Group provides charity care for person who are poor. Charity care is also provided through many reduced price services and free programs offered throughout the year based upon activities and services which Franciscan Medical Group believes serve a bona fide community health need. These include community education service cost for the community, classes for children that cover health care topics, emergency response, fire safety, bike and traffic safety, photo and fingerprinting, electrical safety, seat belts and other care safety, and other community health topics. It is significant to note that all of the Franciscan Medical Group primary care clinics operate in communities designated by the US Department of Health as medically underserved areas for access to primary care. Health Fairs, Events and Screenings Franciscan Medical Group provides cholesterol screenings, glucose screenings, blood pressure checks, and health education information to the community. In fiscal year 2011, these screenings and community health education opportunities reached approximately 7,200 people in our communities. FMG managers provided a minimum of 850 volunteer hours serving our communities. Fundraisers Supported Alzheimer's Association American Cancer Society - Relay for Life American Heart Association American Diabetes Association American Red Cross - Mt Rainier Chapter United Way Muscular Dystrophy Association Tacoma Rescue Mission Leukemia and Lymphoma Society Salvation Army Franciscan Foundation - Cornerstone Club Franciscan Foundation - St Joseph Hospital Ball Franciscan Foundation - St Francis Hospital Gala Franciscan Foundation - Hospice Golf Tournament Franciscan Foundation - St Francis Hospital Golf Tournament Franciscan Foundation - St Clare Hospital Golf Tournament Enumclaw Community Hospital Foundation Catholic Charities Most of these fundraising activities were supported by actual fundraising activities, but most were also supported by cash donations from Franciscan Medical Group.
EXECUTIVE COMMITTEE
FORM 990, PART VI, Q. 1A
THE EXECUTIVE COMMITTEE CONSISTS ONLY OF DIRECTORS OF THE CORPORATION and is composed of two physician directors, one community representative NON-PHYSICIAN DIRECTOR AND THE CHAIRPERSON OF THE BOARD (UNLESS SUCH CHAIRPERSON OF THE BOARD IS ALSO ONE OF THE OTHER QUALIFIED MEMBERS, IN WHICH CASE THE FOURTH MEMBER SHALL BE A DIRECTOR APPOINTED BY THE CHAIRPERSON OF THE BOARD). THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT THE ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIODS BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT THEIR ACTIONS ARE CONSISTENT WITH ANY ACTIONS OR POLICIES OF THE BOARD OR THE CORPORATE MEMBER. ALL ACTIONS TAKEN ARE CONTEMPORANEOUSLY DOCUMENTED AND REPORTED TO THE BOARD AT THE EARLIEST MEETING.
MEMBERS OR SHAREHOLDERS
FORM 990, PART VI, Q. 6
THE SOLE MEMBER OF THE ORGANIZATION IS Franciscan Health System, A Washington NONPROFIT CORPORATION.
MEMBER ELECT ONE OR MORE MEMBERS OF GOVERNING BOARD
FORM 990, PART VI, Q. 7A
THE SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
GOVERNING POWERS
FORM 990, PART VI, Q. 7B
Franciscan Medical Group's ("FMG")corporate member is Franciscan Health System ("FHS"). Pursuant to Section 5.4 of FMG's bylaws, both FHS and Catholic Health Initiatives ("CHI") (FHS's Sole Corporate Member) have specific rights set forth and reserved in the CHI governance matrix. Pursuant to the governance matrix the following rights are reserved to the FHS Board: 1. Approve members of the FMG board 2. Amendment of the corporate documents of FMG 3. Approve Removal of a member of the governing body of FMG 4. Adoption of long range and strategic plans for FMG The following rights are reserved to the CHI board directly or through powers delegated to the CHI Chief Executive Officer: 1. Substantial change in the mission or philosophy of FMG 2. Removal of a member of the governing body of FMG 3. Approval of issuance of debt by FMG 4. Approval of participation of FMG in a joint venture 5. Approval of formation of a new corporation by FMG 6. Approval of a merger involving FMG 7. Approval of the sale of all or substantially all of the assets of FMG 8. To require the transfer of assets by FMG to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. In addition, pursuant to Section 5.5.2 of the organization's bylaws, FHS or CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate.
PROCESS THE ORGANIZATION USES TO REVIEW THE FORM 990
FORM 990, PART VI, Q. 11b
The CFO reviews the tax return and any necessary changes are included in the final version that is approved for filing with the IRS. In addition, the return is provided to the Board prior to filing. Subsequent to review, the tax department files the return with the appropriate federal agencies, making any non-substantive changes necessary to effect e-filing.
PROCEDURES FOR MONITORING AND ENFORCING THE COI POLICY
FORM 990, PART VI, Q. 12C
Each employee is provided education regarding Conflict of Interest policy at New Employee Orientation. As a part of the annual performance review process, the following statement is initialed by all employees: Conflicts of Interest: "I will comply with the standards and guidelines contained in the Conflict of Interest Policy. I understand that I am responsible for recognizing any situation in which a conflict of interest is present or might arise. I will immediately report any such situation to my Manager/Vice President and will take appropriate action to eliminate or prevent a conflict." The governing body is also required to annually declare conflicts of interests, as well as the Medical Staff leaders. When a conflict is acknowledged, the individuals are prohibited from deliberations and decisions in the transaction. The Executive Committee of the Board reviews all governance conflicts of interests, and at each board meeting the Chairperson asks if there are any conflicts of interests related to current agenda items. Conflicts of Interests are reviewed by the CFO, CEO, Legal or at the appropriate level of management depending on the nature of the conflict of interest.
WRITTEN DOCUMENT RETENTION PLAN
FORM 990 PART VI, LINE 14
WHILE FRANCISCAN MEDICAL GROUP HAS A WRITTEN DOCUMENT RETENTION PLAN, THE GOVERNING BOARD HAS NOT FORMALLY ADOPTED IT.
PROCESS FOR DETERMINING CEO'S COMPENSATION
Form 990 Part VI Line 15a
The organization's CEO's compensation is paid by CHI. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September 2011. In addition, in December 2009, Hay Group completed a comprehensive review of all positions at the level of vice president and above to determine and validate appropriate compensation levels.
PROCESS FOR DETERMINING COMPENSATION
FORM 990, PART VI, Q. 15B
An external compensation firm is used who utilizes actual market data compensation from similar institutions with comparable positions and compensation levels and considering the organization's geographic location. The Executive Committee of the Board annually evaluates and approves the Executive Compensation Arrangement for each executive for fair market value along with other applicable factors relied on by the Board's determination. The supporting documentation becomes part of the minutes of the meeting. This process is completed yearly.
GOVERNING DOCUMENTS - COI POLICY - FINANCIAL STATEMENTS AVAILABLE
FORM 990, PART VI, Q. 19
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.COM. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE WASHINGTON SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS AVAILABLE TO THE PUBLIC IN THE ORGANIZATION'S ADMINISTRATION OFFICES.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII
COMPENSATION 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 EMPLOYEES. REPORTABLE INDIVIDUALS EMPLOYED BY CHI AND FRANCISCAN HEALTH SYSTEM ARE COMPENSATED IN EXCHANGE FOR 60 AND 40 HOUR WORK WEEKS RESPECTIVELY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.