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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
D'YOUVILLE LEADERSHIP SOLUTIONS INC
Employer identification number
27-4675543
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
(A)
D'YOUVILLE SENIOR CARE INC
042510563
9
Yes
0
(B)
D'YOUVILLE TRANSITIONAL CARE INC
271680453
9
Yes
0
(C)
D'YOUVILLE SENIOR LIVING INC
200837361
9
No
0
(D)
D'YOUVILLE ELDERLY HOUSING CORPORATION
043536564
9
No
0
Total
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
D'YOUVILLE LEADERSHIP SOLUTIONS INC
Employer identification number
27-4675543
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
THE FOLLOWING DIRECTORS HAD A BUSINESS RELATIONSHIP: 1) SR. JEANNE ARCHAMBAULT, S.C.O., 2) RAYMOND ANSTISS, JR., 3) SR. PAULA BRADLEY, S.C.O., 4) MARK S. COCHRAN, 5) JERRY FRECHETTE, 6) AMY HOEY, 7) SR. PRESCILLE MALO, S.C.O., 8) NAOMI PRENDERGAST, 9) PHILIP J. TAVANO, M.D., 10) ROBERT YOUNG, 11) MARK ALTENWEG
FORM 990, PART VI, SECTION A, LINE 6
THERE SHALL BE ONE CLASS OF MEMBERSHIP. THE MEMBERS OF THE CORPORATION SHALL BE THOSE PERSONS WHO FROM TIME TO TIME MAY FILL THE POSITIONS OF PROVINCIAL SUPERIOR AND PROVINCIAL COUNCILORS OF THE ST. JOSEPH PROVINCE (THE "PROVINCE") OF THE SISTERS OF CHARITY OF OTTAWA (THE "CONGREGATION").
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS HAVE THE FOLLOWING POWERS AND RIGHTS AS THEY PERTAIN TO ELECTIONS: 1) TO ELECT THE DIRECTORS OF THE ORGANIZATION (OTHER THAN DIRECTORS SERVING EX-OFFICIO) AND TO REMOVE THEM WITH OR WITHOUT CAUSE. 2) TO APPOINT AND REMOVE THE PRESIDENT OF THE CORPORATION IN CONSULTATION WITH THE BOARD OF DIRECTORS. 3) TO RATIFY THE BOARD OF DIRECTORS' ELECTION OF THE CHAIRPERSON OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBERS HAVE THE FOLLOWING ADDITIONAL POWERS AND RIGHTS: 1. TO APPROVE ANY CHANGE TO THE PHILOSOPHY AND MISSION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, AND TO MONITOR COMPLIANCE WITH SAME. 2. TO AMEND AND TO REPEAL THE ARTICLES OF ORGANIZATION AND THE BYLAWS OF THE CORPORATION, AND TO APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CHARTER AND THE BYLAWS (OR OTHER GOVERNING INSTRUMENTS) OF ANY SUBSIDIARY OF THE CORPORATION. 3. TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION, REORGANIZATION OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE SALE, LEASE, ASSIGNMENT OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION, OR THE PURCHASE OR ACQUISITION BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OF AN INTEREST IN ANY CORPORATION, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY, WHETHER NEWLY CREATED OR PREVIOUSLY EXISTING, WHICH INTEREST, IN THE CASE OF A FOR PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR EQUITY INTEREST THEREIN, OR, IN THE CASE OF A NON-PROFIT ENTITY, REPRESENTS TWENTY-FIVE PERCENT OR MORE OF THE VOTING POWER THEREOF OR MEMBERSHIP INTEREST THEREIN. 4. TO APPROVE THE ACQUISITION, SALE, TRANSFER OR ENCUMBRANCE OF ANY REAL ESTATE, OR THE CONSTRUCTION OR DESTRUCTION OF ANY IMPROVEMENTS THEREON, BY THECORPORATION OR ANY SUBSIDIARY OF THE CORPORATION VALUED IN EXCESS OF $250,000 (OR SUCH OTHER AMOUNT AS IS SET BY THE MEMBERS IN WRITING FROM TIME TO TIME). 5. TO APPROVE ALL DEBT OF THE CORPORATION FOR BORROWED MONEY IN EXCESS OF $250,000 (OR SUCH OTHER AMOUNT AS IS SET BY THE MEMBERS IN WRITING FROM TIME TO TIME) BEFORE SUCH DEBT IS INCURRED, AND TO APPROVE ALL CHANGES TO THE TERMS OF ANY SUCH DEBT. 6. TO APPROVE THE SALE, ASSIGNMENT OR TRANSFER BY THE CORPORATION OR ANY SUBSIDIARY OF THE CORPORATION OF ANY EQUITY INTEREST OR MEMBERSHIP INTEREST IN ANY SUBSIDIARY OF THE CORPORATION; TO APPROVE ANY RECLASSIFICATION OR OTHER CHANGE OF ANY CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY RECAPITALIZATION OF ANY SUBSIDIARY OF THE CORPORATION; AND TO APPROVE THE ISSUANCE OF, OR THE CREATION OF ANY OBLIGATION TO ISSUE, ANY EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION, OR ANY INCREASE OR DECREASE IN THE TOTAL NUMBER OF SHARES OF AUTHORIZED CAPITAL STOCK OR OTHER EQUITY SECURITY OF ANY SUBSIDIARY OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 IS FULLY REVIEWED BY THE CFO, CEO AND BOARD TREASURER; IT IS THEN SENT TO ALL TRUSTEES FOR TOP-LEVEL REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C
EACH EMPLOYEE, OFFICER AND KEY EMPLOYEE IS GIVEN THE CONFLICT OF INTEREST POLICY AT ORIENTATION AND IS REQUIRED TO REVIEW THIS POLICY ON AN ON-GOING BASIS USING AN ONLINE EDUCATIONAL SOFTWARE. DIRECTORS ARE GIVING THE POLICY AT ORIENTATION AND REVIEW CHANGES AS THEY OCCUR. THE POLICY COVERS ALL EMPLOYEES AND BOARD MEMBERS AND POTENTIAL CONFLICTS ARE REVIEWED BY MANAGEMENT ON AN ON-GOING BASIS TO ASSURE COMPLIANCE. IDENTIFIED ISSUES ARE DISCUSSED AT THE BOARD LEVEL AND AN APPROPRIATE COURSE OF ACTION IS TAKEN BASED ON THE VIOLATION. TO PREVENT TRADE CONFLICT, ALL MATERIAL EXPENDITURES NEED A MINIMUM OF THREE BIDS FROM CONTRACTORS
FORM 990, PART VI, SECTION B, LINE 15
A COMPENSATION COMMITTEE WAS ESTABLISHED TO REVIEW AND APPROVE THE CEO AND CFO COMPENSATION ANNUALLY. THE ANNUAL REVIEW INCLUDES (BUT IS NOT LIMITED TO) A REVIEW OF MARKET WAGES BY USE OF INDEPENDENT SURVEY OR BY COMPARISON TO INDUSTRY DATA. THE COMPENSATION REVIEW IS DOCUMENTED BY USE OF MINUTES AND IS LOCATED WITHIN THE EMPLOYEES FILE. OFFICERS WITH VOTING RIGHTS ABSTAIN FROM THE REVIEW PROCESS IF A CONFLICT EXISTS. MANAGEMENT AND KEY EMPLOYEE COMPENSATION IS REVIEWED BY THE CEO ON AN ANNUAL BASIS USING THE SAME METHODOLOGY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.