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 JOSEPH HOME CARE NETWORK
Employer identification number
68-0331084
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.") .
1,510
1,195
510
72,703
19,500
95,418
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......
12,631,483
12,160,742
12,474,730
12,304,713
11,308,816
60,880,484
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.
12,632,993
12,161,937
12,475,240
12,377,416
11,328,316
60,975,902
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.)
60,975,902
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...
12,632,993
12,161,937
12,475,240
12,377,416
11,328,316
60,975,902
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
4,274
2,157
376
347
106
7,260
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
4,274
2,157
376
347
106
7,260
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.).
12,637,267
12,164,094
12,475,616
12,377,763
11,328,422
60,983,162
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
99.988 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.985 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.012 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.015 %
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 JOSEPH HOME CARE NETWORK
Employer identification number
68-0331084
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART I, LINE 1 & PART III, LINE 1
AS A MEMBER OF THE ST. JOSEPH HEALTH SYSTEM, ST. JOSEPH HOME CARE NETWORK IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE.
BOARD MEMBER INDEPENDENCE
FORM 990, PART I, LINE 4
PER THE BYLAWS OF ST. JOSEPH HOME CARE NETWORK, TRUSTEES ARE EMPLOYEES OF EITHER THE REPORTING ORGANIZATION OR A RELATED ORGANIZATION. AS THEY RECEIVE COMPENSATION FOR THEIR EMPLOYMENT, THEY ARE NOT CONSIDERED TO BE INDEPENDENT.
DESCRIPTION OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, LINE 6
THE CORPORATE MEMBERS FOR ST. JOSEPH HOME CARE NETWORK ARE ST. JOSEPH HOSPITAL OF EUREKA, REDWOOD MEMORIAL HOSPITAL, QUEEN OF THE VALLEY MEDICAL CENTER AND SANTA ROSA MEMORIAL HOSPITAL.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS
FORM 990, PART VI, LINE 7A
ALL NOMINEES SHALL BE APPOINTED TO THE CORPORATION'S BOARD OF TRUSTEES BY THE CORPORATE MEMBERS, SUBJECT TO THE APPROVAL OF ST. JOSEPH HEALTH SYSTEM, EXCEPT THOSE NOMINEES WHO ARE MEMBERS OF THE SISTERS OF ST. JOSEPH OF ORANGE WHO SHALL BE NOMINATED BY THE CORPORATE MEMBER OF ST. JOSEPH HEALTH SYSTEM AND SHALL REQUIRE NO FURTHER APPROVAL.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS
FORM 990, PART VI, LINE 7B
THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE CORPORATE MEMBERS OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. THE CORPORATE MEMBERS FOR ST. JOSEPH HOME CARE NETWORK ARE ST. JOSEPH HOSPITAL OF EUREKA, REDWOOD MEMORIAL HOSPITAL, QUEEN OF THE VALLEY MEDICAL CENTER AND SANTA ROSA MEMORIAL HOSPITAL.
PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990
FORM 990, PART VI, LINE 11B
THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION, AS APPLICABLE. THE FORM 990 IS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING IS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE APRIL 2012 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTS AND DISCUSSES CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDES A SUMMARY AT THE FULL BOARD MEETING.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST
FORM 990, PART VI, LINE 12C
OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST HE/SHE MAY HAVE. ADDITIONALLY, DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE ST. JOSEPH HOME CARE NETWORK BOARD. IF THE CONFLICT INVOLVES A MEMBER OF THAT BOARD, THE REMAINING BOARD MEMBERS WILL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE OFFICER, TRUSTEE, OR KEY EMPLOYEE MAY NOT BE PRESENT DURING ANY MEETING IN WHICH THE BOARD CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE BOARD CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE BOARD DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE BOARD WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER IN CONSULTATION WITH SJHS GENERAL COUNSEL WILL REVIEW THE BOARD FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE.
PROCESS FOR DETERMINING COMPENSATION
FORM 990, PART VI, LINE 15A
THE BOARD CHAIR IN CONSULTATION WITH HEALTH SYSTEM HUMAN RESOURCES ANNUALLY REVIEWS MARKET INFORMATION FROM VARIOUS SOURCES TO SET EXECUTIVE DIRECTOR COMPENSATION.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC
FORM 990, PART VI, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE.
HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII
RON NAGANO, THE CFO OF ST. JOSEPH HOME CARE NETWORK (SJHCN), IS ALSO THE CFO OF ST. JOSEPH HOME CARE SERVICES (SJHCS) AND ST. JOSEPH HOME HEALTH AGENCY (SJHHA) AND AS SUCH DEVOTES 15 HOURS TO SJHCN AND 35 HOURS PER WEEK TO SJHCS AND SJHHA COMBINED. J. MARC GOLAN, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS A VP OF ST. JOSEPH HEALTH SYSTEM (SJHS) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HIS POSITION AT SJHS. KEVIN KLOCKENGA, CHAIRMAN AND TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE CEO OF SANTA ROSA MEMORIAL HOSPITAL (SRMH) AND SRM ALLIANCE HOSPITAL SERVICES (PVH), AND AS SUCH DEVOTES 43 HOURS PER WEEK TO SRMH AND 7 HOURS PER WEEK TO PVH. DONALD MILLER, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF FINANCE AND CFO OF QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HIS POSITION AT QVMC. WALTER MICKENS, VICE CHAIRMAN AND TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE COO AND EXECUTIVE VICE PRESIDENT OF QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HIS POSITION AT QVMC. MICHEL RICCIONI, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE CFO OF SANTA ROSA MEMORIAL HOSPITAL (SRMH) AND SRM ALLIANCE HOSPITAL SERVICES (PVH), AND AS SUCH DEVOTES 43 HOURS PER WEEK TO SRMH AND 7 HOURS PER WEEK TO PVH. S. ANDREW RYBOLT, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF FINANCE AND CFO OF ST. JOSEPH HOSPITAL OF EUREKA (SJE) AND REDWOOD MEMORIAL HOSPITAL (RMH) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO SJE AND RMH COMBINED. JO SANDERSFELD, VP OF MISSION INTEGRATION AND TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF MISSION INTEGRATION AND SECRETARY OF SANTA ROSA MEMORIAL HOSPITAL (SRMH) AND SRM ALLIANCE HOSPITAL SERVICES (PVH), AND AS SUCH DEVOTES 43 HOURS PER WEEK TO HER POSITION AT SRMH AND 7 HOURS TO HER POSITION AT PVH. CLYDE WESP, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE SVP CHIEF MEDICAL OFFICER OF ST. JOSEPH HEALTH SYSTEM (SJHS) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HIS POSITION AT SJHS. LINDA GLOMP, TRUSTEE AND EXECUTIVE DIRECTOR OF ST. JOSEPH HOME CARE NETWORK (SJHCN), IS ALSO THE EXECUTIVE DIRECTOR OF ST. JOSEPH HOME CARE SERVICES (SJHCS) AND ST. JOSEPH HOME HEALTH AGENCY (SJHHA) AND AS SUCH DEVOTES 25 HOURS PER WEEK TO SJHCN AND 25 HOURS PER WEEK TO SJHCS AND SJHHA COMBINED. JUDY BEGLEY, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP AND CNO OF ST. JOSEPH HOSPITAL OF EUREKA (SJE) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HER POSITION AT SJE. ROBERT DIEHL, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF QUALITY AND STRATEGIC SERVICES OF QUEEN OF THE VALLEY MEDICAL CENTER (QVMC) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HIS POSITION AT QVMC. LISA SHIRK, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF ANCILLARY AND SUPPORT SERVICES OF ST. JOSEPH HOSPITAL OF EUREKA (SJE) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO HER POSITION AT SJE. CAROL CONNER, TRUSTEE OF ST. JOSEPH HOME CARE NETWORK, IS THE VP OF FINANCE OF ST. JOSEPH HEALTH SYSTEM (SJHS) AND AS SUCH DEVOTES 50 HOURS PER WEEK TO SJHS.
OVERSIGHT OF SELECTION PROCESS
FORM 990, PART XII, LINE 2C
THE ST. JOSEPH HEALTH SYSTEM BOARD APPROVES THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.