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 Community Health Services
Employer identification number
71-0897107
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)
CATHOLIC HEALTH INITIATIVES
470617373
0
Yes
Yes
Yes
0
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 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 Community Health Services
Employer identification number
71-0897107
Identifier
Return Reference
Explanation
FORM 990, PART III, Q. 4A
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
Introduction St. Joseph Community Health Services (SJCHS) is a non-profit organization that works to ensure that children reach kindergarten with the health and family capacity necessary to support learning. St. Joseph achieves this goal through 3 primary programs: Home Visiting, Enhanced Referral Services & Advocacy. During fiscal year FY 2011 SJCHS provided benefits to the economically disadvantaged in the amount of $1,521,434 and to the broader community in the amount of $1,116,081. Those dollars represented 7,277 contacts with residents of the state of New Mexico. Number Community of Persons Benefit Served Benefits for those Living in Poverty: Community health services 3,533 942,182 Financial contributions 0 537,018 Other benefit provided to the poor 0 42,234 Total Benefits for those Living in Poverty 3,533 1,521,434 Benefits for the Broader Community: Community health services 2,456 485,383 Donations 0 224,000 Community building activities 1,288 406,698 Total Benefits for the Broader Community 3,744 1,116,081 Total Benefits for those Living in Poverty and the Broader Community 7,277 2,637,515 Total Community Benefits including the Unpaid costs of Medicare 7,277 2,637,515 Community Outreach for those Living in Poverty Home Visiting This second year program is the flagship program of SJCHS providing home visits by trained professionals to expectant moms and families with first born children. SJCHS utilizes an outcomes-based model (First Born) that has proven results in improving child and family outcomes. The benefits of early intervention and health promotion in maternal and child health are well-documented and have a lifetime affect. The net benefit provided to the community by this program during fiscal year 2011 was $942,182 and included 3,533 contacts Rubin Eye Fund SJCHS provided funding to the New Mexico Lions Eye Foundation, an entity affiliated with the Lions Club International, a volunteer organization, to fund several different programs including the operation of a 34 foot motor home specifically designed and compartmented for eye care, annual screening for children three to five years old and the provision of used eye-wear to needy individuals. The net benefit provided to the community for the fiscal year was approximately $83,200, including a grant of $65,000 to the Foundation. Community Support This program consists mostly of donations provided by SJCHS to various programs around New Mexico serving the poor. The net benefit provided directly by SJCHS to the poor was $453,818, Miscellaneous Programs This category covers events sponsored by SJCHS throughout the year, principally the SJCHS Celebration of Babies Event and the CHI Mission and Ministry meeting. The net benefit provided to the community by these programs was $42,234. Community Outreach for the Broader Community Enhanced Referral & Advocacy These two programs operate in conjunction with the Home Visiting program (see above). The Enhanced Referral program provides services to address housing, legal aid, transportation, medical care, access to food, child care, employment, dental care, school re-entry and special needs services. Addressing these underlying social-environmental factors has been shown to impact physical health, emotional/social development, family capacity and functioning. The Advocacy program provides funding for state-wide advocacy efforts to support early childhood development issues/programs. In supporting these two programs SJCHS provided a net benefit to the community of $485,383 and made 2,456 contacts. Women's Economic Strengthening Project (EARN) This project is a partnership initiative with the Rio Grande Community Development Corporation and focuses on assisting immigrant women in establishing cottage businesses. During the fiscal year the net benefit to the community was $406,698 and encompassed 1,288 contacts. Nancy Floyd Haworth Memorial Breast Cancer Lectureship This lectureship series provides education for breast cancer survivors and their supportive partners on issues related to medical advances in treatment and on survivorship issues focusing on wellness. The objective is to educate diverse audiences and address topics not covered by other cancer support agencies or treatment centers. During fiscal year 2011, SJCHS spent $64,000 on this project, including a grant of $50,000 to the organization. Cancer Programs SJCHS provided funding to the Children's Cancer Fund of New Mexico whose primary purpose is to assist children and their families in coping with the day-to-day emotional, financial, and educational needs of living with and fighting cancer. The net benefit provided to the community for the fiscal year was approximately $160,000, including a grant of $125,000 to the organization.
FORM 990, PART VI, Q. 1A
EXECUTIVE COMMITTEE
SJCHS HAS AN EXECUTIVE COMMITTEE THAT CONSISTS ONLY OF DIRECTORS OF THE CORPORATION AND IS COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE PRESIDENT AND CEO, EACH OF WHOM SERVE AS EX OFFICIO VOTING MEMBERS OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT THE ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD 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.
FORM 990, PART VI, Q. 6
MEMBERS OR STOCKHOLDERS
PER THE ORGANIZATION'S BYLAWS, SECTION 5.1, THE SOLE MEMBER OF THE ORGANIZATION IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION.
FORM 990, PART VI, Q.7A
ELECTING DIRECTORS
PURSUANT TO THE ORGANIZATION'S BYLAWS, SECTION 6.5, THE SOLE MEMBER HAS THE POWER TO APPOINT ORGANIZATION DIRECTORS, AND AFTER RECOMMENDATION BY THE BOARD OF DIRECTORS, MAY ACCEPT OR REJECT ANY INDIVIDUAL NOMINATED TO SERVE AS A DIRECTOR. THE SOLE MEMBER MAY ALSO UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS IF THE BOARD FAILS TO FURNISH A LIST OF QUALIFIED INDIVIDUALS TO SERVE.
FORM 990, PART VI, Q. 7B
Approval of Governing Body Decisions by Members/Stockholders
"The organization's corporate member is Catholic Health Initiatives ("CHI"). Pursuant to Section 5.1 of the organization's amended bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix 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 St. Joseph Community Health Services. -Amendment of the corporate documents of St. Joseph Community Health Services. -Approve members of the St. Joseph Community Health Services board. -Removal of a member of the governing body of the St. Joseph Community Health Services. -Approval of issuance of debt by St. Joseph Community Health Services. -Approval of participation of St. Joseph Community Health Services in a joint venture. -Approval of formation of a new corporation by St. Joseph Community Health Services. -Approval of a merger involving the St. Joseph Community Health Services. -Approval of the sale of all or substantially all of the assets of the St. Joseph Community Health Services. -To require the transfer of assets by the St. Joseph Community Health Services to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. -Adoption of long range and strategic plans for St. Joseph Community Health Services. Pursuant to Section 5.5 of the organization's bylaws, 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.
FORM 990, PART VI, Q. 11
PROCESS USED TO REVIEW 990
THE Director of Finance REVIEWS THE FORM 990 AND FACILITATES THE distribution OF THE RETURN TO THE BOARD OF DIRECTORS. SUBSEQUENT TO distribution TO THE BOARD AND director of finance, 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.
FORM 990, PART VI, Q. 12C
MONITORING OF CONFLICT OF INTEREST POLICY
SJCHS BOARD MEMBERS AND STAFF COMPLY WITH THE ST JOSEPH CONFLICT OF INTEREST POLICY. BOTH STAFF AND BOARD MEMBERS REVIEW THE POLICY ANNUALLY AND COMPLETE CONFLICT OF INTEREST DISCLOSURE STATEMENTS. POTENTIAL CONFLICTS OF INTEREST ARE REPORTED TO THE VICE PRESIDENT OR THE BOARD CHAIRMAN FOR STAFF AND BOARD MEMBERS RESPECTIVELY. THESE INDIVIDUALS REVIEW THE SITUATION AND DETERMINE IF AN ACTUAL CONFLICT EXISTS. BOARD MEMBERS WITH A CONFLICT ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON THOSE MATTERS.
FORM 990, PART VI, Q. 15A
PROCESS FOR DETERMINING CEO COMPENSATION
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.
FORM 990, PART VI, Q. 15B
PROCESS FOR DETERMINING COMPENSATION
FOR ALL OF THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVES, OUTSIDE CONSULTANTS ANNUALLY REVIEW COMPENSATION USING MULTIPLE NATIONAL COMPARABILITY SURVEYS. ADDITIONALLY, THE EXECUTIVE COMMITTEE REVIEWS AND APPROVES COMPENSATION AND ALL DISCLOSURES AND DECISIONS ARE CONTEMPORANEOUSLY DOCUMENTED.
FORM 990, PART VI, Q. 19
PUBLIC INSPECTION OF DOCUMENTS
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 CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE NOT PUBLICLY AVAILABLE.
Form 990, Part VII
Estimate of Hours Devoted to related organizations
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, 60 hour-per-week employees.
Form 990, Part XI, Q.6
Other Changes in Net Assets or Fund Balances
St. Joseph Community Health Services' other changes in net assets are as follows: Net unrealized gain/loss - $7,645,672 K-1 Distributions - $ 7,515 Capital Resource Contributions - $ (38,976) Total - $7,614,211
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.