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
Daughters of Charity Services of San Antonio
Employer identification number
74-6106876
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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.") ....
4,379,101
3,068,317
3,788,918
3,679,694
4,331,849
19,247,879
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
4,379,101
3,068,317
3,788,918
3,679,694
4,331,849
19,247,879
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)..
7,182,236
6
Public support. Subtract line 5 from line 4.
12,065,643
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..
4,379,101
3,068,317
3,788,918
3,679,694
4,331,849
19,247,879
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
8,011
1,977
317
11,028
21,333
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
1,045,224
1,105,905
1,306,511
49,400
47,079
3,554,119
11
Total support (Add lines 7 through 10).
22,823,331
12
Gross receipts from related activities, etc. (see instructions)
..................
12
5,678,272
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
52.865 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
49.630 %
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.)
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
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
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
Explanation
Schedule A (Form 990 or 990-EZ) 2012
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
2012
Open to Public Inspection
Name of the organization
Daughters of Charity Services of San Antonio
Employer identification number
74-6106876
Identifier
Return Reference
Explanation
ORGANIZATIONS MISSION
FORM 990, PART III, QUESTION 1
FAITHFUL TO THE VINCENTIAN TRADITION, THE DAUGHTERS OF CHARITY SERVICES OF SAN ANTONIO WILL ESTABLISH AND MAINTAIN NEIGHBORHOOD-BASED PROGRAMS TO INCREASE ACCESSIBILITY TO PRIMARY HEALTH CARE AND HUMAN SERVICES ON THE PART OF THE POOR. THESE PROGRAMS WILL HAVE A STRONG HOLISTIC ORIENTATION AND CONSIDER PARTICIPATION AND EMPOWERMENT AS AN INTEGRAL DIMENSION OF THE DELIVERY OF SERVICE. WHILE SERVICES WILL BE RENDERED WITH PREFERENTIAL OPTION FOR THE POOR, IT IS NOT TO THE EXCLUSION OF OTHERS.
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, QUESTION 6
THE ORGANIZATION HAS ONE MEMBER, ASCENSION HEALTH.
MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY
FORM 990, PART VI, QUESTION 7A
THE ORGANIZATION HAS ONE MEMBER, ASCENSION HEALTH, WHO HAS SOLE AUTHORITY ELECTING THE MEMBERS OF THE GOVERNING BODY.
MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, QUESTION 7B
THE BYLAWS STATE THAT THE BOARD OF TRUSTEES OF THE CORPORATION SHALL NOT TAKE ACTION ON THE FOLLOWING LIST OF ITEMS WITHOUT THE APPROVAL OF THE MEMBER: 1. APPROVE THE MISSION AND VISION STATEMENTS FOR THE CORPORATION, 2. APPROVE THE FORMATION OR ACQUISITION OF NEW LEGAL ENTITIES FOR WHICH ASCENSION HEALTH WILL SERVE AS THE SOLE OR CONTROLLING ENTITY AND, SUBJECT TO CANONICAL REQUIREMENTS, APPROVE THE SALE, TRANSFER, OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OF THE DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP, OR CORPORATE REORGANIZATION OF THE CORPORATION, 3. APPROVE REQUIREMENTS, APPROVE CHANGES, AND ASSURE COMPLIANCE WITH REQUIREMENTS FOR GOVERNING DOCUMENTS OF THE CORPORATION AND ITS ORGANIZATIONS, 4. APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHAIR OF THE BOARD OF THE CORPORATION, 5. APPROVE THE TRANSFER OF ASSETS AND THE REALLOCATION OF DEBT AMONG THE CORPORATION AND OTHER REGIONAL/LOCAL HEALTH MINISTRY ORGANIZATIONS IN ACCORDANCE WITH THE NATIONAL SYSTEM AUTHORITY MATRIX, 6.APPROVE THE TRANSFER OR ENCUMBRANCE OF THE ASSETS OF THE CORPORATION AND ITS SUBSIDIARY HOSPITAL CORPORATIONS, IF ANY, IN ACCORDANCE WITH THE NATIONAL SYSTEM AUTHORITY MATRIX, 7. APPROVE THE STRATEGIC AND FINANCIAL PLANS AND CONSOLIDATED CAPITAL AND OPERATING BUDGETS FOR THE CORPORATION, OR 8. APPROVE THE INCURRENCE OF DEBT OF THE CORPORATION OR ITS SUBSIDIARY ORGANIZATIONS IN EXCESS OF LIMITS SET FORTH IN THE NATIONAL SYSTEM AUTHORITY MATRIX.
PROCESS TO REVIEW THE FORM 990
FORM 990, PART VI, QUESTION 11B
DRAFT OF 990 IS REVIEWED BY CEO AND CFO, FORWARDED TO FINANCE COMMITTEE FOR REVIEW, THEN IT IS ALSO FORWARDED TO ASCENSION HEALTH'S (CORPORATE SPONSOR) TAX ACCOUNTANTS FOR REVIEW, PRIOR TO FILING. A COPY OF THE 990 IS PROVIDED TO ALL THE GOVERNING BODY BEFORE FILING.
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY
FORM 990, PART VI, QUESTION 12C
CONFLICT OF INTEREST QUESTION IS ASKED AT EVERY BOARD MEETING AND WRITTEN CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY ALL BOARD MEMBERS AND SENIOR MANAGEMENT ANNUALLY.
REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION
FORM 990, PART VI, QUESTION 15A
A REVIEW IS DONE BY THE ENTIRE BOARD OF DIRECTORS IN EXECUTIVE SESSION AFTER THE AUDITED FINANCIAL STATEMENTS ARE PRESENTED. A COMPENSATION REVIEW IS DONE PERIODICALLY BY AN INDEPENDENT CONSULTANT.
REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION
FORM 990, PART VI, QUESTION 15B
DIRECTORS' SALARIES ARE REVIEWED BY IMMEDIATE SUPERVISORS AND A FINAL REVIEW AND APPROVED BY THE CEO. ALL EVALUATIONS ARE BASED ON ESTABLISHED GOALS IN THE PRECEDING YEAR. A COMPENSATION REVIEW IS DONE PERIODICALLY BY AN INDEPENDENT CONSULTANT.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
FORM 990, XI, LINE 9
PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS, INCLUDED AS OTHER CHANGE IN NET ASSETS FOR FINANCIAL STATEMENTS (18,613)
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:PHYSICIAN FEES TOTAL FEES:371892
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:LAB FEES TOTAL FEES:41505
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:RADIOLOGY FEES TOTAL FEES:4285
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:MEDICAL WASTE DISPOSAL FEES TOTAL FEES:12640
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:TEMPORARY STAFFING FEES TOTAL FEES:25568
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:PAYROLL SERVICE FEES TOTAL FEES:99269
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:MAINTENANCE SERVICE FEES TOTAL FEES:13639
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:46097
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.