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
Carondelet Home Care Services Inc
Employer identification number
43-1379352
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.") .
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, Part IV, Supplemental Information: Carondelet Home Care Services, Inc. is exempt as a hospital under Internal Revenue Code Section 170(b)(1)(A)(iii); however it is not a hospital as defined by Form 990, Schedule H instructions. Per Schedule H instructions, a hospital is a facility that is, or is required to be, licensed, registered, or similarly recognized by a state as a hospital, and Carondelet Home Care Services, Inc. does not meet any of those criteria.
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
Carondelet Home Care Services Inc
Employer identification number
43-1379352
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
Carondelet Home Care Services, Inc. has a single corporate member, Carondelet Health.
Form 990, Part VI, Section A, line 7a
Carondelet Home Care Services, Inc. has a single corporate member, Carondelet Health who has the ability to elect members to the governing body of the Carondelet Home Care Services, Inc.
Form 990, Part VI, Section A, line 7b
All decisions that have a material impact to the Carondelet Home Care Services, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Carondelet Health.
Form 990, Part VI, Section B, line 11
Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review and answer any questions. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions.
Form 990, Part VI, Section B, line 12c
The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Section B, line 15
In determining compensation of the organization's top management official (Fleury Yelvington), the process performed by Carondelet Health (a related organization) included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the top management official was compared to individuals in similar positions of other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individual was not present when her compensation was decided. In determining compensation of other officers of the organization, the process performed by Carondelet Health (a related organization) included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensations, the other officers of the organization were compared to other organizations' employees in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the audit committee minutes. Individuals were not present when their compensation was decided.
Form 990, Part VI, Section C, line 19
The organization will provide any documents open to public inspection upon request.
Explanation of Hours for Officers:
Form 990, Part VII, Section A:
Officers (Fleury Yelvington, Steve Cleary, Scott Kashman, and Carla Brogdon) of Carondelet Home Care Services, Inc. provide services to Carondelet Health and its subsidiaries. Hours worked are not tracked on an entity by entity basis. Therefore, the hours for officers and directors noted above reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week for all entities.
Changes in Net Assets or Fund Balances:
Form 990, Part XI, line 5:
Net unrealized losses on investments: -1,441. Transfer to Sponsor 292. Total to Form 990, Part XI, Line 5: -1,149.
Description of organization's Audited Financial Statement:
Form 990, Part XII, Line 2c:
The financial statements of Carondelet Home Care Services, Inc. fall under the limited scope audit of Carondelet Health. The activity of Carondelet Home Care Services, Inc. and other members of the Carondelet Health System are reported in the consolidated financial statements of Ascension Health. No individual audit of Carondelet Home Care Services, Inc. is completed.
Form 990, Part III:
Carondelet Health - Kansas City Community Benefit Report For the year ended June 30, 2011 Carondelet Health consists of St. Mary's Medical Center, St. Joseph Medical Center, three long-term care facilities and home care services. Carondelet Health is dedicated to the healing ministry of Jesus Christ. Our commitment to human dignity compels us to provide compassionate, quality healthcare for body, mind and spirit, with a special concern for the poor. We are responsible stewards serving the needs of all people from conception to death. Carondelet Health is a member of Ascension Health, the nation's largest Catholic and nonprofit health system. With Charity for All: The downturn in the American economy these last few years has proved challenging for everyone involved in health care. Not-for-profit hospitals have felt the increasing number of patients who have no insurance, are underinsured and cannot pay the full cost of their care. Comparative health care costs have soared since the Sisters of St. Joseph of Carondelet started Kansas City's first hospital in a three-story house in downtown Kansas City. Today, Carondelet Health provides financial assistance to uninsured patients at both St. Joseph and St. Mary's Medical Centers. If patients are eligible for Medicaid, the Medical Centers will assist with the application. Carondelet Health also helps patients who need extra time to settle their bills with an interest-free, extended-term payment plan, regardless of their employment or credit history. Carondelet Health is also deeply involved in educating the public about the challenges for those without health insurance. Each year it joins other organizations in Cover the Uninsured Week. Carondelet Health created a resource guide for the uninsured that is used throughout the region and is available in both English and Spanish. In keeping with the rich tradition of the founding Sisters of St. Joseph of Carondelet and the Sisters of St. Mary, St. Joseph and St. Mary's turn away no one in need. The sister's commitment to providing compassionate, quality care remains visible at the Medical Centers to this day. Caring for Our Community: Carondelet Health's facilities are active members of the communities they serve, offering a long list of programs and services to help care for the physical, mental, social and spiritual health of the residents living in those communities. Here are some highlights: The Health Sciences Library at St. Joseph Medical Center: This library facility welcomes anyone wishing to learn more about health, disease and wellness. Visitors have access to print, video and computerized health information. - Support Groups: Both medical centers offer groups for bereavement, Alzheimer's, stroke, infant loss, Lyme disease, diabetes, battered women and other areas of need. - Informative Web site and Health Magazine: Our newly redesigned Web site, Carondelethealth.org offers health information and direct links to more than fifty health-related organizations and support groups. Health Wise, our community health magazine is full of interesting and educational health features and is available on our Web site or by mail. - High Risk Obstetrics Care: Our Healthy Beginnings program provides counseling and pre- and post-natal care for underinsured, uninsured and Medicaid mothers going through high-risk pregnancies. - Seniors Clinic: Located at St. Joseph Medical Center, this popular program addresses the health needs of homebound seniors and residents of long-term care and assisted living facilities. The clinic provides a comfortable, convenient, cost-effective setting where seniors' needs can be assessed, diagnosed and treated by physicians. The clinic also provides free transportation for many patients. - Free Wellness Services: Carondelet Health provides wellness services to nine churches in its service area and to designated low-income patients. - Classroom Space: Space is provided for alternative high school classes offered by the Kansas City School District. Other local not-for-profit agencies are invited to host meetings and seminars in the medical centers for a nominal fee. - Contributions to Community Groups: Carondelet Health contributes to many worthwhile organizations, including Cristo Rey High School, the American Cancer Society, the American Heart Association and Catholic Charities of Kansas City. It supports the Seton Center Family and Health Services by providing human resources, maintenance and wellness services; and funds after school programs for at-risk children at YMCAs in Kansas City and Blue Springs. - Involvement with Community Events: St. Joseph and St. Mary's participate in numerous health fairs, offering free blood pressure, blood sugar and prostate cancer screenings. Together the medical centers sponsor a domestic violence rally to raise awareness about this critical issue and to support area victims. St. Joseph also coordinates a free informational seminar with the American Diabetes Association. Caring for the Poor: Charitable Losses by Carondelet Health of Kansas Fiscal Year 2011 (July 1, 2010 - June 30, 2011) Unpaid Medicare Reimbursement $7.4 million Unpaid Medicaid reimbursement $7.8 million Traditional Charity $3.5 million Collectable Debt $4 million Community Services $1.3 million Subsidized Services $2.8 million Total Community Benefit: $23 million Carondelet Home Care Services Fiscal Year 2011 (July 1, 2010 - June 30, 2011) 1) Care of the poor - at cost - $1,470 2) Government sponsored health care - net expense - $13,474 Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs: does not include Medicare shortfall) 3) Community Benefit Programs - net expense - $0 Total quantifiable community benefit as determined in accordance with CHA reporting guidelines - $14,494 Total quantifiable community benefit - $14,494
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.