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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
MERCY HOSPITAL SCRANTON PA |
240795456 | 3 | Yes | Yes | Yes | 75,000 | |||
| (2)
COMMUNITY MEDICAL CENTER |
240862246 | 3 | Yes | Yes | Yes | 75,000 | |||
| (3)
MOSES TAYLOR HOSPITAL |
240795461 | 3 | Yes | Yes | Yes | 75,000 | |||
| Total | 225,000 | ||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | HCC HAS 3 MEMBERS AS FOLLOWS: 1) COMMUNITY MEDICAL CENTER FOUNDATION, A PENNSYLVANIA NONPROFIT CORPORATION; 2) MERCY HOSPITAL, SCRANTON, A PENNSYLVANIA NONPROFIT CORPORATION; 3) MTH RESOURCES, INC., A PENNSYLVANIA NONPROFIT CORPORATION. |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | THE BOARD OF TRUSTEES SHALL CONSIST OF THE RESPECTIVE CHIEF EXECUTIVE OFFICERS OF COMMUNITY MEDICAL CENTER, MERCY HOSPITAL, SCRANTON AND MOSES TAYLOR HOSPITAL, WHO SHALL BE EX OFFICIO VOTING MEMBERS OF THE BOARD, AND AT LEAST THREE ADDITIONAL ELECTED MEMBERS, THE NUMBER TO BE DETERMINED FROM TIME TO TIME BY RESOLUTION OF THE BOARD; PROVIDED, HOWEVER, THAT THE NUMBER OF ELECTED BOARD MEMBERS MAY ONLY BE INCREASED BY MULTIPLES OF THE NUMBER THREE SO THAT EACH MEMBER IS ENTITLED TO ELECT THE SAME NUMBER OF ELECTED TRUSTEES AT ALL TIMES AS ALL OTHER MEMBERS ARE ENTITLED TO ELECT AS SPECIFIED IN SECTION 4.02. ELECTED MEMBERS OF THE BOARD OF TRUSTEES SHALL BE SELECTED FOR THEIR ABILILTY TO PARTICIPATE EFFECTIVELY IN FULFILLING THE RESPONSIBILITIES OF THE BOARD. SECTION 4.02 - ELECTION - VOTING BY THE MEMBERS OF THE CORPORATION SOLELY FOR THE PURPOSE OF ELECTING TRUSTEES SHALL BE BY CLASS VOTE, WITH EACH MEMBER OF THE CORPORATION CONSTITUTING ITS OWN CLASS, WITH EACH CLASS VOTING SEPARATELY AND WITH EACH CLASS ENTITLED TO CAST ITS VOTES FOR THE ELECTION OF THE SAME NUMBER OF TRUSTEES AT ALL TIMES AS EACH OTHER CLASS IS ENTITLED TO ELECT. THE ELECTED TRUSTEES SHALL HOLD OFFICE FROM THE TIME OF THEIR ELECTION UNTIL THEIR SUCCESSORS HAVE BEEN DULY ELECTED AND HAVE QUALIFIED. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | VACANCIES IN TRUSTEE POSITIONS, INCLUDING VACANCIES RESULTING FROM ANY INCREASE IN THE AUTHORIZED NUMBER OF TRUSTEES, SHALL BE FILLED IN THE SAME MANNER SPECIFIED IN SECTION 4.02, WITH EACH MEMBER OF THE CORPORATION ENTITLED TO ELECT A NEW TRUSTEE OR TRUSTEES AS NECESSARY SO THAT THERE ARE AN EQUAL NUMBER OF ELECTED TRUSTEES REPRESENTING EACH MEMBER OF THE CORPORATION ON THE BOARD OF TRUSTEES AT ALL TIMES. ANY MEMBER OF THE CORPORATION MAY REMOVE ANY TRUSTEE ELECTED BY IT AT ANY TIME. THE BOARD OF TRUSTEES MAY DECLARE VACANT THE OFFICE OF A TRUSTEE WHO IS DECLARED OF UNSOUND MIND BY AN ORDER OF COURT, OR CONVICTED OF A FELONY, OR FOR ANY OTHER PROPER CAUSE, OR IF, WITHIN SIXTY DAYS AFTER NOTICE OF SUCH TRUSTEE'S ELECTION, SUCH TRUSTEE DOES NOT ACCEPT SUCH OFFICE EITHER IN WRITING OR BY ATTENDING A MEETING OF THE BOARD. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | THE FORM 990 IS PREPARED BY THE CATHOLIC HEALTH PARTNERS TAX DEPARTMENT AND REVIEWED BY THE BOARD OF HEALTHCARE CORPORATION OF NORTHEASTERN PENNSYLVANIA. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | IT IS RECOGNIZED THAT OCCASIONS MAY ARISE WHEN A MEMBER OF THE BOARD OF TRUSTEES OR OFFICER OF THE CORPORATION HAS A FINANCIAL INTEREST IN A CONTRACT OR TRANSACTION UPON WHICH ACTION IS TO BE TAKEN OR WITHHELD BY SUCH BOARD OR A COMMITTEE. IT IS THE POLICY OF THE CORPORATION AND OF ITS BOARD OF TRUSTEES THAT: A) ANY MATERIAL FACTS AS TO SUCH FINANCIAL INTEREST SHALL BE DISCLOSED BY SUCH MEMBER OR OFFICER TO THE MEMBERS OF SUCH BOARD OR COMMITTEE. SUCH DISCLOSURE SHALL BE RECORDED IN AN ANNUAL CONFLICT OF INTEREST STATEMENT SIGNED BY SUCH MEMBER AND OFFICER OR, IF NOT PREVIOUSLY DISCLOSED IN SUCH STATEMENT, WHEN THE MATTER AT INTEREST COMES UP FOR ACTION BY SUCH BOARD OR COMMITTEE. B) THE MEMBER OR OFFICER HAVING SUCH FINANCIAL INTEREST ON ANY MATTER SHALL NOT VOTE OR USE ANY PERSONAL INFLUENCE IN REGARD TO THE MATTER (EXCEPT THAT THE MEMBER MAY STATE A POSITION ON THE MATTER AND RESPOND TO QUESTIONS ABOUT IT); HOWEVER, SUCH MEMBER OF OFFICER MAY BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING AT WHICH THE MATTER IS VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THAT THE DISCLOSURE WAS MADE AND THE ABSTENTION FROM VOTING. C) THE BOARD OR COMMITTEE MAY AUTHORIZE ANY CONTRACT OR TRANSACTION BETWEEN THE CORPORATION AND ANY SUCH MEMBER OR OFFICER, OR BETWEEN THE CORPORATION AND ANY CORPORATION, ASSOCIATION, OR OTHER ORGANIZATION IN WHICH SUCH MEMBER OR OFFICER IS A DIRECTOR OR OFFICER OR HAS A FINANCIAL INTEREST, UNLESS SUCH CONTRACT OR TRANSACTION WOULD BE IN VIOLATION OF APPLICABLE LAW, INCLUDING SECTION 7728 OF THE CODE. THIS POLICY SHALL BE REVIEWED BY THE BOARD ANNUALLY FOR THE INFORMATION AND GUIDANCE OF MEMBERS OF THE BOARD AND OFFICERS, AND BROUGHT TO THE ATTENTION OF NEW MEMBERS OF THE BOARD AND OFFICERS. |
| Governing documents, conflict of interest policy and financial statements available to the public | Form 990, Part VI, Section C, Line 19 | HCC'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND ARTICLES OF INCORPORATION ARE AVAILABLE UPON REQUEST. |
| Average number of hours devoted per week to related organization | Form 990, Part VII, Section A, Column B | BARBARA BOSSI - 40 KEVIN COOK - 50 MICHAEL M. COSTELLO - 40 STEPHEN H. FRANKO, III - 48 KAREN MURPHY - 40 SEAN MCANDREW - 40 |
| COMPENSATION NOT PROVIDED | FORM 990, PART VII, SECTION A | NONE OF THE OFFICERS OR TRUSTEES RECEIVED ANY COMPENSATION FROM THE FILING ORGANIZATION. ALL COMPENSATION RECEIVED BY THE OFFICERS AND TRUSTEES WAS PAID BY RELATED ORGANIZATIONS WHICH ARE SUPPORTED BY THE FILING ORGANIZATION. PLEASE REFER TO THE FORMS 990 FILED BY COMMUNITY MEDICAL CENTER AND MOSES TAYLOR HOSPITAL FOR DISCLOSURES REGARDING COMPENSATION RECEIVED BY THEIR EMPLOYEES WHO ARE LISTED ON PART VII OF THE FILING ORGANIZATION. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | EQUITY DISTRIBUTIONS - -225000; |
| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |