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
SAINT FRANCIS MEDICAL CENTER FOUNDATION
Employer identification number
47-0630267
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.") ....
804,619
960,638
701,170
800,509
755,405
4,022,341
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..
804,619
960,638
701,170
800,509
755,405
4,022,341
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)..
101,826
6
Public Support. Subtract line 5 from line 4.
3,920,515
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..
804,619
960,638
701,170
800,509
755,405
4,022,341
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
929,427
1,095,595
431,624
321,306
315,595
3,093,547
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..
50,844
36,963
52,249
48,129
63,998
252,183
11
Total support (Add lines 7 through 10).
7,368,071
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
81,776
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
53.209 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
49.981 %
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
SAINT FRANCIS MEDICAL CENTER FOUNDATION
Employer identification number
47-0630267
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, Q. 4A
ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE The Saint Francis Medical Center Foundation was incorporated as a 501(c)(3), tax-exempt, charitable foundation in 1981 to serve as the official gift-receiving and gift-administration agency for Saint Francis Medical Center in Grand Island, Nebraska. The healthcare foundation was established to help further the hospital's mission of providing healthcare services to all in need and improving the health of the communities that it serves. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT The Saint Francis Foundation's current 4-member staff and 20-member Board of Directors raise funds through special events, annual giving, major gifts, planned giving, corporate/foundation grants and capital campaigns to help fund many of the healthcare programs projects and community outreach services offered by the hospital. In addition, the Saint Francis Foundation provides funding for numerous community-sponsored programs that compliment the Foundation's mission and work toward the creation of healthier communities. In FY 11 the Saint Francis Medical Center Foundation distributed $608,198 back into the community through its financial support of Saint Francis Medical Center and community-sponsored programs. Additionally, another $247,027 was provided through in-kind support and fiduciary support of community projects. Programs supported financially included the Third City Community Clinic, which provides primary care and dental care to low-income residents, Saint Francis Child Safety which promotes usage of child safety seats, and the Parish Nurse program at St. Mary's Cathedral. In addition, funds support the Student Wellness Center, which provides primary healthcare services to students at Grand Island Senior High and Walnut Middle School along with Project Care, which helps Saint Francis patients address medical needs that aren't covered by insurance or existing programs. The Saint Francis Foundation also provided funding for oncology services, violence prevention initiatives, a teen parenting program and interpreter services for limited English speaking patients.
EXECUTIVE COMMITTEE
FORM 990, PART VI, Q. 1A
The Executive Committee CONSISTS OF officers of the Corporation. 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 SAINT FRANCIS MEDICAL CENTER, A NEBRASKA NONPROFIT CORPORATION.
MEMBER ELECT ONE OR MORE MEMBERS OF GOVERNING BOARD
FORM 990, PART VI, Q. 7A
THE SOLE MEMBER, Saint Francis Medical Center, HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
GOVERNING POWERS
FORM 990, PART VI, Q. 7B
The organization's corporate member is Saint Francis Medical Center. Pursuant to Article V Section 3 of the organization's bylaws, Saint Francis Medical Center, CHI Nebraska (Saint Francis Medical Center's sole corporate member) and Catholic Health Initiatives (CHI Nebraska's sole corporate member) ("CHI") have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the Saint Francis Medical Center Board: Approve members of the Saint Francis Medical Center Foundation board Amendment of the corporate documents of Saint Francis Medical Center Foundation Approve removal of a member of the governing body of Saint Francis Medical Center Foundation Adoption of long range and strategic plans for Saint Francis Medical Center 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 Saint Francis Medical Center Foundation Removal of a member of the governing body of Saint Francis Medical Center Foundation Approval of issuance of debt by Saint Francis Medical Center Foundation Approval of participation of Saint Francis Medical Center Foundation in a joint venture Approval of formation of a new corporation by Saint Francis Medical Center Foundation Approval of a merger involving Saint Francis Medical Center Foundation Approval of the sale of all or substantially all of the assets of Saint Francis Medical Center Foundation To require the transfer of assets by Saint Francis Medical Center Foundation to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Article V Section 4 of the organization's bylaws, Saint Francis Medical Center 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.
PROCESS, IF ANY, THE ORGANIZATION USES TO REVIEW FORM 990
Form 990, Part VI, Q. 11A
Once the return is prepared, the return is reviewed by the Chief Financial Officer. Subsequent to review by the Chief Financial Officer, the tax department files the return with the appropriate federal and state 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
ST. FRANCIS MEDICAL CENTER FOUNDATION HAS A BOARD POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. AT THE ANNUAL BOARD AND BOARD COMMITTEE MEETINGS ALL MEMBERS ARE REQUESTED TO SIGN CONFLICT OF INTEREST STATEMENTS. THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE FILES. ALL MEMBERS ARE REQUESTED TO DECLARE POTENTIAL CONFLICTS OF INTEREST AT EACH BOARD AND/OR COMMITTEE MEETING OF THE BOARD. IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING. IN ADDITION, A QUESTIONNAIRE IS SENT ANNUALLY TO ALL BOARD MEMBERS AND TOP PAID EMPLOYEES ASKING THEM TO DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS.
PROCESS FOR DETERMINING EXECUTIVE COMPENSATION
FORM 990, PART VI, Q. 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
During the tax year ended 6/30/11, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by a compensation committee utilizing an independent consultant and comparability studies and the appropriate board oversight to determine compensation.
GOVERNING DOCUMENTS, COI POLICY, AND 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 Nebraska Secretary of State's website. The conflict of interest policy is not available to the public.
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, 40 HOUR-PER-WEEK EMPLOYEES.
RECONCILIATION OF NET ASSETS
990 PART XI, LINE 5
net unrealized gains/(losses) $2,233,225 temporarily restricted assets $(187,484) ----------- 2,045,741
business relationship
990 part vi, q.2
CINDY JOHNSON IS AN EMPLOYEE OF THE CHAMBER OF COMMERCE WHERE WILL ARMSTRONG IS A BOARD MEMBER.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.