Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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| Yes | No | Yes | No | Yes | No | ||||
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| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
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| 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. | ||||||
| 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). | ||||||






| 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.") . | 332,795 | 249,227 | 292,165 | 253,592 | 216,635 | 1,344,414 |
| 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...... | 14,325,925 | 15,302,166 | 15,277,165 | 16,978,349 | 17,283,938 | 79,167,543 |
| 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. | 14,658,720 | 15,551,393 | 15,569,330 | 17,231,941 | 17,500,573 | 80,511,957 |
| 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.) | 80,511,957 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 14,658,720 | 15,551,393 | 15,569,330 | 17,231,941 | 17,500,573 | 80,511,957 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 96,459 | 81,940 | 82,056 | 77,468 | 74,386 | 412,309 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 96,459 | 81,940 | 82,056 | 77,468 | 74,386 | 412,309 |
| 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.). | 14,755,179 | 15,633,333 | 15,651,386 | 17,309,409 | 17,574,959 | 80,924,266 |




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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| PROGRAM SERVICE ACCOMPLISHMENTS | FORM 990, PART III, Q. 4A | I. INTRODUCTION Villa Nazareth, Inc. operates two distinct entities, 1) Friendship, Inc. and 2) Riverview Place. Friendship, Inc.'s origin dates back to 1897 to St. John's Orphanage. Over the years the name and the mission of the organization have changed to meet the needs of the community. In 1981, Villa Nazareth (dba Friendship, Inc.) was created to serve people with developmental disabilities in a non-institutional, community-based program. Today, Friendship, Inc. is one of the largest non-profit private providers of community services to people with developmental disabilities in North Dakota. Over 260 people with developmental disabilities are served by Friendship, Inc. in a variety of vocational and residential programs. Villa Nazareth (dba Riverview Place) is a retirement community for active adults. Riverview Place was formed in 1987 offering 148 independent apartment settings to people aged 55 and older. As seniors began to age in place, an assisted living program was developed and approximately 50 out of the 148 apartments were designated as assisted living. A health service component was added to assist residents with their healthcare needs. Today Riverview Place serves over 150 retired seniors. During the fiscal year 2011 Villa Nazareth provided benefits to the poor and broader community of $152,537 as described below. Approximately 6,516 people benefited from these services. The major components of these community benefits are as follows: Number of Persons Community Served Benefit Benefits for the Poor Cost of Charity Care 5 $45,498 Family & Community Living and Extended Services 95 $6,546 Community Service targeted for poor 190 $20,742 Total Benefits for the Poor 290 $72,786 Benefits for the Broader Community Education and Research 1,779 $72,179 Other Community Benefits 4,447 $7,572 Total Benefits for Broader Community 6,226 $79,751 Total Benefits 6,516 $152,537 II. BENEFITS FOR THE POOR Charity Care In the fiscal year 2011 Riverview Place provided $45,498 to five people through their Charity Care Program. The Charity Care Program was implemented to allow seniors to remain at Riverview Place and receive necessary services despite their shrinking ability to pay for the costs. As seniors aged and life expectancies were exceeded, a few of the residents found their financial means could not afford to keep pace with costs at Riverview Place. We had five residents who qualified. Family & Community Living and Extended Services At Friendship, Inc. we pride ourselves in serving people with developmental disabilities who are of a more challenging nature. Our Family and Community Living Program (FCL) is one of these programs. Because this program is a Medicaid Waivered Program and because of the more challenging people who are in this program, costs associated with the program exceed reimbursement levels. The Extended Services program assists people with developmental disabilities in finding meaningful employment of their choice, and provides job coaching as well as transportation to and from the job sites. Because each individual is given the dignity of choosing their job, transportation needs often require many job coaches to travel to many different job sites. Reimbursement for the travel time is not made available from Medicaid, and therefore the costs associated with providing this program often exceed the reimbursement levels. The growth experienced and the dignity realized by the people we serve is extremely important to us. This year costs exceeded reimbursements by $6,546 in these two programs. There are a total of 95 people who receive these services. Community Service Targeted for the Poor Friendship employs 350 employees in three communities. Even though salaries and turnover are improving, we still need to support an atmosphere of reverence and appreciation for staff members by including sponsorships in softball leagues, bowling leagues, volleyball leagues, etc. In addition, flowers are given when losses occur or illness is experienced. Memberships in organizations above what reimbursement regulations allow help provide a support system and exchange of ideas. These types of activities are considered non-allowable costs, yet they help create an atmosphere of caring. Staff members are taking leadership roles in memberships in the Kiwanis, Qualified Mental Retardation Professional (QMRP) Association, Chamber of Commerce, and the Association for Persons in Supported Employment (APSE). Staff members who experience this respect stay longer. When staff members stay longer, consistency in programming occurs and quality of service is improved to people with developmental disabilities. When situations occur that are non-reimbursable for the people we support, in cases of extreme need, we are committed to helping. Situations where there is job loss, wages have changed significantly, a person is temporary ineligible for Medicaid, or there is a need for medical equipment that is not covered by Medicare are some examples of what we consider extreme need. This year, $20,742 was spent to assist 190 people served. III. BENEFITS FOR THE BROADER COMMUNITY Education and Research Riverview Place serves as a host site for Communiversity, a program offering enriching educational opportunities for community members. The Communiversity program hosted 48 sessions over the course of FY 2011 with total attendance of approximately 316 people. Also, the Giving Plus Learning Program served 1,463 new Americans in its tenth year. The Giving Plus Learning Program is designed to match senior mentors with new Americans by helping them adapt to live in the United States. The total calculated benefit for these two extremely important and educational programs was $72,179. Other Community Benefits Riverview Place Chapel is open for members of the community to attend daily Mass and ecumenical services throughout the year. 4,443 community members attended services this past year at a cost of $6,861. Employee Involvement in Community Projects Villa Nazareth employees are brought on board with training that promotes our core values: Reverence, Compassion, Integrity and Excellence. These values are put to work by several of them to help people in need. They proudly participate in several community events during the year. The value of their time donated was $711. See details below. Number of Employees Number of Hours Event/Cause Participating Donated United Way Day of Caring 4 32 Total 4 32 |
| EXECUTIVE COMMITTEE | FORM 990, PART VI, Q. 1A | The Executive Committee CONSISTS only OF directors of the Corporation and IS composed of the Chairperson of the Board, the Vice Chairperson of the Board, and the President and CHIEF Executive OFFICEr, each of whom serve as ex officio voting members of the Executive Committee, and TWO memberS appointed by the Board of Directors. 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 CATHOLIC HEALTH INITIATIVES, A COLORADO 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 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. |
| GOVERNING POWER | FORM 990, PART VI, Q. 7B | The organization's corporate member is Catholic Health Initiatives ("CHI"). 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 VILLA NAZARETH, INC. - Amendment of the corporate documents of VILLA NAZARETH, INC. - Approve members of the VILLA NAZARETH, INC. board - Removal of a member of the governing body of VILLA NAZARETH,INC. - Approval of issuance of debt by VILLA NAZARETH, INC. - Approval of participation of VILLA NAZARETH, INC. in a joint venture - Approval of formation of a new corporation by VILLA NAZARETH, INC. - Approval of a merger involving VILLA NAZARETH, INC. - Approval of the sale of all or substantially all of the assets of VILLA NAZARETH, INC. - To require the transfer of assets by VILLA NAZARETH, INC. to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. - Adoption of long range and strategic plans for VILLA NAZARETH, INC. PURSUANT TO 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. |
| Process the Organization uses to review form 990 | FORM 990, PART VI, Q. 11B | Once the return is prepared, the return is reviewed by the organization's Finance, Audit and Compliance Committee prior to the FAC meeting on March 22, 2012. The controller/Treasurer will review any significant items and will field any questions at the FAC meeting. The FAC Committee will then vote to recommend approval of the return to the full Board. Subsequent to providing the return to the board 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. |
| PROCEDURES FOR MONITORING AND ENFORCING THE COI POLICY | FORM 990, PART VI, Q. 12C | THE CONFLICT OF INTEREST POLICY IS covered in "Our Values and Ethics at Work" booklet which all employeeS receive and acknowledge by signing the certification WHich is part of the booklet. THEY ALSO PARTICIPATE IN AN ANNUAL LEARNING COURSE ABOUT THE TOPIC. All Board members must sign a Conflict of Interest Disclosure Statement annually. When conflicts of interest are considered by the Board, the director or officer must disclose all of the material facts to the Board. The director or officer DOES not vote or use his or her personal influence on the matter. However, if requested, such director or officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from Board members, as his or her knowledge may be of significant importance. The director or officer shall be excused from the meeting during discussion and vote on the conflict of interest |
| Whistleblower Policy | Form 990, Part VI, Line 13 | The Whistleblower policy for Catholic Health Initiatives has not been formally adopted by the Board of Directors. However, CHI's position regarding whistleblowers is contained in the "Our Values and Ethics at Work Reference Guide." The whistleblower process in the Reference Guide reads as follows: "Rights of Employees, Contractors and Agents to be Protected as Whistleblowers Under the False Claims Act - Federal and many state false claims acts protect employees from retaliation if they, in good faith, report fraud. Employees are protected against retaliation such as being fired, demoted, threatened or harassed as a result of filing a false claims act lawsuit. An employee who suffers retaliation can sue, may receive up to twice his/her back pay, plus interest; reinstatement at the seniority level they would have had if not for the retaliation; and compensation for costs or damages. Amendments to the federal False Claims Act in 2009 extend whistleblower protections beyond employees by also safeguarding contractors and agents from retaliation for investigating or preventing a potential false claim." |
| Process for Determining CEO's 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 | The CEO of Fargo division does a market study to determine if the salaries of the senior management team are comparable. A salary range is set for each position, this range is adjusted annually based on the approved percentage increase of the Medicaid budget as set by the state of North Dakota Department of Human Services. This percentage adjustment is keeping the senior management's salary range marketable. In addition, the division office of CHI in Fargo and the Compensation committee of the Board also review and approve the salary ranges of the senior management team. |
| Public Inspection of Documents | FORM 990, PART VI, Q. 19 | The Organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. 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.org. Additionally, the organization's governing documents are available ON THE NORTH DAKOTA SECRETARY OF STATE'S WEBSITE. |
| Other changes in net assets or fund balances | 990 Part XI, Question 5 | Villa Nazareth Inc.'s other changes in net assets are as follows: Net unrealized gain/loss - $250,168 CHI connect depreciation - $ 90,435 Capital Resource pool contribution - $(27,229) Total - $313,374 |
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