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
2012
Open to Public Inspection
Name of the organization
CARITAS INC
Employer identification number
05-0369463
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
1,542,870
1,090,493
973,621
629,808
370,938
4,607,730
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..
185,000
185,000
185,004
185,004
185,004
925,012
4
Total. Add lines 1 through 3
1,727,870
1,275,493
1,158,625
814,812
555,942
5,532,742
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.
5,532,742
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
1,727,870
1,275,493
1,158,625
814,812
555,942
5,532,742
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
9
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
80,893
2,138
83,031
11
Total support (Add lines 7 through 10).
5,615,782
12
Gross receipts from related activities, etc. (see instructions)
..................
12
5,364,639
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
98.520 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
98.360 %
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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.)
0
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
0 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
OTHER INCOME PART II, LINE 10; DESCRIPTION: MISCELLANEOUS; 2011: 80893.; 2012: 2138.;
Explanation
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000225
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
2012
Open to Public Inspection
Name of the organization
CARITAS INC
Employer identification number
05-0369463
Identifier
Return Reference
Explanation
Pt VI, Line 3
All management duties such as fiscal management, human
resource management, janitorial and facilities
management are contracted with the parent company,
Gateway Healthcare, Inc.
Pt VI, Line 4
Effective June 30, 2013 Caritas, Inc. shall
be merged with and into Gateway Healthcare, Inc. pursuant
to and with the effect provided by the laws of the State
of Rhode Island, including without limitation, the provisions
of the Rhode Island Nonprofit Corporation Act, R.I. Gen.
Laws 7-6-1 through 108. The Corporation existence of
Caritas, Inc. shall cease at the Effective Time,
and Gateway shall survive such merger and continue its
existence under its Articles of Incorporation as now in
effect. The assets and liabilities of Caritas, Inc. acquired
by Gateway shall be taken on the books and records of Gateway
at the amounts in which they are carried at the Effective
time of the merger on the books and records of Caritas, Inc.
Pt VI, Line 6
Gateway Healthcare, Inc. is the sole corporate member
of Caritas, Inc.
Pt VI, Line 7a
The bylaws of Caritas, Inc. (Caritas) confer certain
reserved powers on Gateway Healthcare, Inc. (Gateway)
to provide it with the means of effective oversight,
coordination and support of the system. Powers
reserved to Gateway include: to elect and remove
trustees and to approve the election of and removal of
certain officers. At each annual meeting of Caritas's
Form 990, Part IX, Line 24f
GRANT EXPENSE 25604. 22850. 2754. 0. 0. 0. 0. RUBBISH 5373. 5373. 0. 0. POSTAGE 1250. 574. 676. 0. MISCELLANEOUS EXPENSE 857. 32. 825. 0. BANK SERVICE CHARGES 625. 0. 625. 0. DUES & SUBSCRIPTIONS 125. 125. 0. 0.
Board of Trustees, a list is compiled of the names of
those persons selected to serve as Trustees of Caritas
so that it can be approved and submitted to Gateway
for ratification and election.
Pt VI, Line 7b
Gateway has the responsibility for planning, directing,
and establishing policy to assure the development and
delivery of quality health and social services,
professional education, and biomedical research on an
integrated, cost effective basis with each
organization directly or indirectly owned or controlled
by Gateway. Powers reserved to Gateway, in addition
to those noted above, include: to approve amendment of
Articles of Incorporation and Bylaws and other Charter
documents; strategic plans; to approve investment
policies and any capital or operating budgets or
material non-budgeted expenditures; and to authorize
incurrence or guaranty of material indebtedness.
Pt VI, Line 11b
The preparation and filing of the Form 990 and supporting
schedules is the responsibility of the Chief Financial Officer (CFO)
and Finance Department of Gateway Healthcare, Inc. and Affiliates (Gateway).
The Form 990 is prepared by the Gateway Finance Department staff upon
completion of the annual independent financial statement audit. A draft of the
Form 990 is then provided to the Lifespan Corporation Tax Compliance Manager
for further review. Once the draft Form 990 is complete, the Gateway CFO
forwards it along with all supporting worksheets to KPMG, which then reviews
the completed form in detail. The CFO answers questions as they arise and
provides information as needed. KPMG provides the CFO with any recommended
changes which are reviewed, and if agreed upon, are incorporated into the return.
The draft form 990 is then provided to the CFO for final management review.
Prior to filing Form 990 with the Internal Revenue Service,
the EVP & CFO of Lifespan Corporation will coordinate
a video presentation to the Board of Directors to review
the return and discuss the highlights that occurred during
the year. After this presentation any questions and
comments will be addressed and any changes, if necessary,
based on comments from the Board are included in the return.
Once the Form 990 is complete and ready to be filed, the
members of the Board are notified via email that a copy
of the final version of the Form 990 is accessible
through a password protected website portal. The CFO
is then authorized to file the Form 990.
Pt VI, Line 12c
Gateway Healthcare, Inc. (Gateway) has a Conflict of
Interest Policy that is applicable to all Gateway
Healthcare affiliates, including Caritas, Inc.
(Caritas), and is administered by Gateway's Board
Chairperson. The President/CEO annually distributes
conflict of interest disclosure forms to Board members,
Leadership, and others as determined by the Board. All
receiving these disclosure forms are to complete and
return them as directed. When a conflict or potential
conflict is disclosed, the Board Chair and/or
President/CEO are to determine the appropriate response
to the disclosure, consulting with legal counsel as
necessary and reporting the conflict and response to
the Board and to others, including providers when
deemed appropriate. At anytime that a Board or
Leadership member has knowledge of a real or potential
conflict of interest as defined in Gateway's Bylaws,
he/she is to disclose such to the Board Chair or
President/CEO and is not to vote or in other ways make
decisions that relate to the area of conflict.
Pt VI, Line 15a
The compensation of the President/CEO is determined
by the Gateway Healthcare, Inc. Board of Directors
and is reviewed annually following the annual
performance evaluation process. The Executive
Committee of the Board who is independent of
management and free of any conflicts of interest that
would interfere with their exercise of independent
judgment serves as a compensation committee and
approves the compensation decision in advance of
payment. The Committee reviews the current salary and
compares it to available compensation data for local
non-profits and regional behavioral health providers.
The Committee adequately documents the basis for its
determination concurrently upon making the compensation
decision.
Pt VI, Line 19
The organization makes its governing documents,
conflict of interest policies, financial statements,
and 990 returns available upon request. The
organization will provide copies to those who come to
the administrative office during normal business hours
or request a copy by US mail.
Pt VII, Col (E)
Richard Leclerc is the CEO and Scott DiChristofero is
the CFO of Gateway Healthcare, Inc., the sole corporate
member of Caritas, Inc. Their compensation is paid
directly from Gateway Healthcare, Inc. and they have
no voting powers on the Caritas, Inc. Board.
Pt XI
A transfer of net assets totaling $438,036 was made
to Gateway Healthcare as of June 30, 2013.
Part V Line 7b
The Agency had sent out donor acknowledgement letters to
the various contributors of the events, however the letters
did not contain the recognized tax deductible information.
Upon merging into Gateway as of June 30, 2013, the Gateway development
office has implemented policies and procedures related
to the issuance of acknowledgements as required
by Internal Revenue Code Section 6115. This policy
is effective for fundraising activities commencing after
January 1, 2014 and includes all fundraising activities
previously conducted by Caritas, Inc.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.