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
FRANCISCAN COMMUNITIES ST MARY OF THE WOODS INC
Employer identification number
51-0436466
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.") ....
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
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.") .
325,415
726,140
105
1,051,660
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......
7,581,335
7,323,391
7,852,691
6,972,847
29,730,264
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
47,309
42,166
39,581
14,933
0
143,989
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
7,954,059
8,091,697
7,892,377
6,987,780
0
30,925,913
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
0
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.
0
0
0
0
0
0
c
Add lines 7a and 7b..
0
0
0
0
0
0
8
Public support (Subtract line 7c from line 6.)
30,925,913
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...
7,954,059
8,091,697
7,892,377
6,987,780
0
30,925,913
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
130,314
88,714
52,023
7,940
278,991
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
130,314
88,714
52,023
7,940
0
278,991
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
0
0
0
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
8,084,373
8,180,411
7,944,400
6,995,720
0
31,204,904
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
99.100 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
98.740 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.890 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
1.250 %
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:
12000266
Software Version:
v2012.1.0
-
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
FRANCISCAN COMMUNITIES ST MARY OF THE WOODS INC
Employer identification number
51-0436466
Identifier
Return Reference
Explanation
SIGNIFICANT CHANGES IN PROGRAM SERVICES
FORM 990, PART III, LINE 3
FRANCISCAN COMMUNITIES ST. MARY OF THE WOODS ("ST. MARY OF THE WOODS") FILED FOR RELIEF UNDER CHAPTER 11 OF THE FEDERAL BANKRUPTCY LAWS ON NOVEMBER 21, 2011. WHILE UNDER THE CONTROL OF THE BANKRUPTCY COURT, ST. MARY OF THE WOODS EXECUTED THE SALE OF CERTAIN ASSETS AND LIABILITIES. THE PROCEEDS OF THE SALE WERE SUBJECT TO THE RULINGS OF THE BANKRUPTCY. THE ASSETS SOLD CONSISTED PRIMARILY OF PROPERTY, PLANT, EQUIPMENT, ACCOUNTS RECEIVABLE, AND OTHER CURRENT ASSETS. THE BUYER ASSUMED RESIDENCY AGREEMENT OBLIGATIONS AND CERTAIN EMPLOYEE BENEFIT OBLIGATIONS. EXCLUDED FROM THE SALE WERE CASH, CERTAIN ACCOUNTS PAYABLE, ACCRUED EXPENSES, AND TOLEDO LUCAS COUNTY PORT AUTHORITY REVENUE BOND OBLIGATIONS ("REVENUE BOND OBLIGATIONS"). THE OBLIGATIONS UNDER THE NONRECOURSE DEBT OF ST. MARY OF THE WOODS WERE THE SOLE OBLIGATION OF ST. MARY OF THE WOODS. NEITHER THE FRANCISCAN SISTERS OF CHICAGO SERVICE CORPORATION ("SERVICE CORPORATION"), THE SOLE CORPORATE MEMBER, NOR ANY OF ITS AFFILIATES WERE OBLIGATED UNDER ST. MARY OF THE WOOD'S DEBT. UPON FILING FOR BANKRUPTCY, THE SERVICE CORPORATION DECONSOLIDATED ST. MARY OF THE WOODS. THE ASSET PURCHASE AGREEMENT WAS DATED MARCH 7, 2012 AND THE TRANSACTION CLOSED ON MAY 22, 2012. ON NOVEMBER 21, 2012 ("THE DISMISSAL DATE"), ST. MARY OF THE WOODS RECEIVED A FINAL DISMISSAL ORDER OF THE CHAPTER 11 CASE, GRANTING CERTAIN RELIEF BY THE BANKRUPTCY COURT. THE FINAL DISMISSAL ORDER STRIPPED ANY OBLIGATION OF ST. MARY OF THE WOODS FOR THE REMAINING LIABILITIES ON THE BALANCE SHEET AS OF THE DISMISSAL DATE INCLUDING THE REVENUE BOND OBLIGATIONS. AS OF THE DISMISSAL DATE, THE BALANCE SHEET REPORTED CASH AND INVESTMENTS OF $325,615, WHICH WERE UNDER THE CONTROL OF THE BANKRUPTCY COURT. AS SUCH, AS OF THE DISMISSAL DATE, THERE WERE NO ASSETS OR LIABILITIES TO BE REPORTED FOR ST. MARY OF THE WOODS. ON NOVEMBER 19, 2012, ST. MARY OF THE WOODS FILED ARTICLES OF DISSOLUTION.
JUDY AMIANO AND RONALD TINSLEY - BUSINESS RELATIONSHIP
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
FRANCISCAN COMMUNITIES ST MARY OF THE WOODS, INC. FILED ARTICLES OF DISSOLUTION WITH THE ILLINIOIS SECRETARY OF STATE ON NOVEMBER, 19, 2012. ON NOVEMBER 19, 2012, ST. MARY OF THE WOODS FILED ARTICLES OF DISSOLUTION, DISSOLVING ANY GOVERNING BODY TO WHOM WE WOULD PRESENT THE FORM 990.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
AS PROVIDED FOR IN THE CONFLICT OF INTEREST POLICY, IT IS THE RESPONSIBILITY OF THE BOARD OR COMMITTEE CHAIR TO ENSURE THAT EACH DIRECTOR, OFFICER, AND MEMBER OF A BOARD COMMITTEE ANNUALLY SIGNS AN FSCSC APPROVED CONFLICT OF INTEREST DISCLOSURE STATEMENT. COPIES OF ALL SIGNED STATEMENTS ARE FORWARDED TO THE CORPORATE DIRECTOR OF COMPLIANCE AND STANDARDS. KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT THAT IS REVIEWED BY THEIR DIRECT SUPERVISOR. POTENTIAL CONFLICTS OF INTEREST OF BOARD MEMBERS ARE BROUGHT TO THE ATTENTION OF THE BOARD CHAIR. AFTER DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE A DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED ON. PROPOSED TRANSACTIONS WITH INTERESTED PERSONS OF THE BOARD OF DIRECTORS OR COMMITTEES REQUIRES THE APPROVAL OF THE BOARD PRIOR TO ENTERING INTO THE PROPOSED TRANSACTION OR ARRANGEMENT. THE INTERESTED PERSON SHALL NOT BE PRESENT DURING THE PRESENTATION OR THE VOTE ON THE PROPOSED TRANSACTION OR ARRANGEMENT. KEY EMPLOYEES, OFFICERS AND HIGHEST COMPENSATED EMPLOYEES ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT THAT IS REVIEWED BY THEIR DIRECT SUPERVISOR. THE SUPERVISOR WILL WORK WITH THE COMPLIANCE OFFICER AND POSSIBLY HUMAN RESOURCES IN TAKING APPROPRIATE STEPS TO ADDRESS THE POTENTIAL.
EXECUTIVE COMPENSATION
FORM 990, PART VI, LINE 15A
THE ORGANIZATION DID NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES DURING THE CALENDAR YEAR ENDING WITH OR WITHIN THE ORGANIZATION'S SHORT TAX YEAR BEGINNING JULY 1, 2012 AND ENDING NOVEMBER 19, 2012. ST. MARY OF THE WOODS FILED ARTICLES OF DISSOLUTION ON NOVEMBER 19, 2012. THEREFORE THESE QUESTIONS ARE NOT APPLICABLE, BUT HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
OTHER OFFICERS OR KEY EMPLOYEES COMPENSATION
FORM 990, PART VI, LINE 15B
THE ORGANIZATION DID NOT COMPENSATE ANY OFFICERS OR KEY EMPLOYEES DURING THE CALENDAR YEAR ENDING WITH OR WITHIN THE ORGANIZATION'S SHORT TAX YEAR BEGINNING JULY 1, 2012 AND ENDING NOVEMBER 19, 2012. ST. MARY OF THE WOODS FILED ARTICLES OF DISSOLUTION ON NOVEMBER 19, 2012. THEREFORE THESE QUESTIONS ARE NOT APPLICABLE, BUT HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS.
Governing documents, conflict of interest policy and financial statements available to the public
Form 990, Part VI, Section C, Line 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC IN ACCORDANCE WITH APPLICABLE LAWS AND REGULATIONS.
Other Expenses
Form 990, Part IX, Line 11g
PROFESSIONAL CONSULTING FEES - TOTAL EXPENSE: 264195, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 264195, FUNDRAISING EXPENSES: ;
Other changes in net assets or fund balances
Form 990 , Part XI, Line 9
TRANSFER OF NET ASSETS BALANCE AS OF DISSOLUTION DATE. NET ASSETS UNDER CONTROL OF BANKRUPTCY COURT AS OF DATE OF FINAL DISMISSAL ORDER, NOVEMBER 21, 2012. - -325615;
FINANCIAL STATEMENT AND REPORTING
FORM 990, PART XII, LINE 2A
FRANCISCAN COMMUNITIES ST. MARY OF THE WOODS ("ST. MARY OF THE WOODS") FILED FOR RELIEF UNDER CHAPTER 11 OF THE FEDERAL BANKRUPTCY LAWS ON NOVEMBER 21, 2011. WHILE UNDER CONTROL OF THE BANKRUPTCY COURT, ST. MARY OF THE WOODS WAS NOT REQUIRED TO FILE AUDITED FINANCIAL STATEMENTS. UPON FILING FOR BANKRUPTCY, THE FRANCISCAN SISTERS OF CHICAGO SERVICE CORPORATION ("SERVICE CORPORATION") DECONSOLIDATED ST. MARY OF THE WOODS. THEREFORE, ST. MARY OF THE WOODS WAS NO LONGER INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF THE SERVICE CORPORATION. FRANCISCAN COMMUNITIES ST. MARY OF THE WOODS FILED ARTICLES OF DISSOLUTION ON NOVEMBER 19, 2012.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.