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
2011
Open to Public Inspection
Name of the organization
CHRISTIANA CARE HEALTH SYSTEM INC
Employer identification number
52-1479538
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.") ....
6,766,735
21,226,194
7,841,546
3,781,451
3,466,482
43,082,408
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..
6,766,735
21,226,194
7,841,546
3,781,451
3,466,482
43,082,408
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)..
18,102,829
6
Public Support. Subtract line 5 from line 4.
24,979,579
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
6,766,735
21,226,194
7,841,546
3,781,451
3,466,482
43,082,408
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
817,278
634,884
39,257
35,617
24,463
1,551,499
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..
0
43,081
84,656
86,100
21,557
235,394
11
Total support (Add lines 7 through 10).
44,869,301
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
55.672 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
66.824 %
16a
33 1/3% support test—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.)
Section B. Total Support
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.).
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
CHRISTIANA CARE HEALTH SYSTEM INC
Employer identification number
52-1479538
Identifier
Return Reference
Explanation
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11
INFORMATION RELATED TO THE CHRISTIANA CARE HEALTH SYSTEM INC.("SYSTEM") FORM 990 FILING IS GATHERED BY FINANCE STAFF AND PROVIDED TO PRICEWATERHOUSECOOPERS LLP FOR REVIEW. THE FINAL 2011 FORM 990 FOR THE FISCAL YEAR ENDING JUNE 30, 2012 WAS REVIEWED AND APPROVED BY VARIOUS SENIOR MANAGEMENT OFFICIALS. THE ORGANIZATION'S GOVERNING BOARD WAS ALSO PROVIDED ACCESS TO THE APPROVED 2011 FORM 990 VIA ITS BOARD OF DIRECTOR'S PORTAL.
CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
OUR CONFLICT OF INTEREST ("COI") POLICY IS LOCATED IN THE SUPERVISORY POLICY MANUAL. THERE IS AN ANNUAL MANDATORY EDUCATION FOR REQUIRED INDIVIDUALS WHICH INCLUDES AN ELECTRONIC SIGN OFF ACKNOWLEDGING COMPLETION OF THE EDUCATION, REPORTING OF A REAL OR PERCEIVED CONFLICT OR THAT NO CONFLICTS OF INTEREST EXISTS. THE HR/EMPLOYEE RELATIONS TEAM FOLLOWS UP WITH ANYONE WHO HAS A CONFLICT OR PERCEIVED CONFLICT OR DOES NOT COMPLETE THE EDUCATION IN ORDER TO RESOLVE. THE EMPLOYEE HANDBOOK SETS EXPECTATIONS FOR EMPLOYEE CONFLICTS OF INTEREST AND EXPECTATIONS. SEVERAL REPORTING MECHANISMS ALSO EXIST FOR EMPLOYEES TO REPORT CONCERNS. THE BOARD OF DIRECTORS HAS THEIR OWN COI POLICY. COI IS A STANDING AGENDA ITEM ON EACH BOARD OR BOARD COMMITTEE MEETING. BOARD MEMBERS EXPECTATIONS FOR COI ARE CLEARLY COMMUNICATED.
COMPENSATION REVIEW AND APPROVAL
FORM 990, PART VI, SECTION B, LINE 15
THIS ORGANIZATION IS AN AFFILIATE OF CHRISTIANA CARE HEALTH SERVICES, INC. ("CCHS"). ALL COMPENSATION ARRANGEMENTS ARE DETERMINED BY AND PAID THROUGH CCHS. COMPENSATION ARRANGEMENTS INVOLVING ANY OF OUR OFFICERS ARE ESTABLISHED BY CCHS PURSUANT TO A PROCESS THAT SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE AVAILABLE FOR SECTION 4958 EXCESS BENEFIT TRANSACTION TAX PURPOSES (WHICH REQUIRES A REVIEW OF COMPENSATION DETERMINATIONS BY DISINTERESTED PERSONS, USE OF APPROPRIATE COMPARABILITY DATA, AND CONTEMPORANEOUS DOCUMENTATION OF THE PROCESS).
GOVERNANCE, MANAGEMENT, AND DISCLOSURE
FORM 990, PART VI, SECTION C, LINE 19
THE FORMS 1023 AND 990, GOVERNING DOCUMENTS, AUDITED FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY OF THE SYSTEM ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE FINANCIAL STATEMENTS ARE AVAILABLE ON THE WEB THROUGH DIGITAL ASSURANCE CERTIFICATION ("DAC").
DETAIL OF OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
NET UNREALIZED GAINS/(LOSSES) $ (18,741) INCOME RELATED TO FUNDRAISING EVENTS (21,557) CONTRIBUTIONS TRANSFERRED TO AFFILIATES (1,396,968) PLEDGES/CONTRIBUTIONS RECEIVED 1,477,677 CHANGE IN PHYSICIANS ORGANIZATION 1,612 INVESTMENT INCOME 43,851 ----------- Total 85,874 ===========
DETAIL OF CONTRIBUTIONS
FORM 990, SCHEDULE B
PER THE INSTRUCTIONS TO THE 2011 FORM 990, CONTRIBUTIONS LISTED ON SCHEDULE B ARE REPORTED PURSUANT TO THE SYSTEM'S ACCRUAL BASIS OF ACCOUNTING. AS SUCH, SOME AMOUNTS REPORTED MAY REPRESENT AMOUNTS THAT HAVE BEEN PLEDGED BY THE DONOR, BUT NOT YET RECEIVED BY THE SYSTEM.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:CAROL A. AMMON TITLE:CHAIRMAN OF THE BOARD HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:PATRICK D. HARKER, PHD TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DONEENE K. DAMON, ESQ TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:OMAR A. KHAN, MD, MHS TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ROBERT J. LASKOWSKI, MD TITLE:PRESIDENT & CEO, EX OFFICIO HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LOLITA A. LOPEZ TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:HON. JOSHUA W. MARTIN, III TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MICHAEL R. MILLER TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:GORDON OSTRUM, JR, MD TITLE:EX OFFICIO MEMBER, VICE CHAIR HOURS:1
NAME:ANAND P. PANWALKER, MD TITLE:EX OFFICIO MEMBER, VICE CHAIR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:THEODORE G. PLUSH TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ERIC T. JOHNSON, M.D. TITLE:MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ARKADI KUHLMANN TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JOHN M. MURRAY II TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MARK TYKOCINSKI, M.D. TITLE:MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:GARY W. FERGUSON TITLE:CHIEF OPER OFF, OFF OF BOARD HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:WILLIAM J. WADE TITLE:OFFICER OF BOARD HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:THOMAS L. CORRIGAN TITLE:SR VP FINANCE/CFO, OFF OF BD HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:BRENDA K. PIERCE, ESQ. TITLE:2ND ASST SECRETARY OF THE CORP HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
TY 2011 AffiliatedGroupAttachment
Name:
CHRISTIANA CARE HEALTH SYSTEM INC
EIN: 52-1479538
Explanation:
DIRECT OTHER LOBBYING EXEMPT PURPOSE NAME OF ELECTING ORGANIZATION EXPENDITURES EXPENDITURES __________________________________ ____________ ______________ CHRISTIANA CARE HEALTH SYSTEM $ NONE $ 3,873,090 CHRISTIANA CARE HEALTH SERVICES 180,295 1,214,160,734 CHRISTIANA CARE HOME HEALTH AND COMMUNITY SERVICES NONE 39,502,311 CHRISTIANA CARE HEALTH INITIATIVES NONE 19,543,364 ------------ -------------- TOTAL $180,295 $1,277,079,499 THE ORGANIZATION HAS MADE THE LOBBYING ELECTION UNDER I.R.C. SECTION 501(H) FOR THE TAX YEAR ENDED JUNE 30, 2012. THIS ELECTION HAS NOT BEEN REVOKED BEFORE THE START OF THE ORGANIZATION'S TAX YEAR THAT BEGAN IN 2011.