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
SISTERS OF CHARITY PROVIDENCE HOSPITALS
Employer identification number
57-0314409
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) 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
SISTERS OF CHARITY PROVIDENCE HOSPITALS
Employer identification number
57-0314409
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE INCLUDES THE CHAIRPERSON, THE VICE CHAIRPERSON, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION, THE SECRETARY, THE TREASURER AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEMBER, OR HIS/HER DESIGNEE. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE IS A SISTER OF CHARITY OF ST. AUGUSTINE. WHEN THE BOARD OF TRUSTEES IS NOT IN SESSION, THE EXECUTIVE COMMITTEE HAS AND EXERCISES ALL OF THE AUTHORITY OF THE BOARD. ALL ACTIONS OF THE COMMITTEE ARE REPORTED TO THE BOARD OF TRUSTEES NOT LATER THAN THE TIME OF ITS NEXT SUCCEEDING MEETING.
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE ORGANIZATION IS THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, AN OHIO NONPROFIT CORPORATION. PLEASE SEE ARTICLE III OF THE BYLAWS FOR DETAILS.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBER OF SISTERS OF CHARITY PROVIDENCE HOSPITALS MAY ELECT MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B
RESERVED POWERS OF THE MEMBER OF THE ORGANIZATION INCLUDE THE POWER AND AUTHORITY TO BORROW OR LEND MONEY, THE PURCHASE AND SALE OF CERTAIN PROPERTY, THE APPOINTMENT OR RENEWAL OF THE REGULATIONS AND ARTICLES OF INCORPORATION, THE ELECTION OF DIRECTORS, AND THE DETERMINATION OF CORPORATE PHILOSOPHY.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 WAS MADE AVAILABLE TO BOARD MEMBERS VIA THE BOARD PORTAL FOR REVIEW AND PRESENTED AT A BOARD MEETING WITH TIME FOR DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 12C
PROVIDENCE HOSPITALS REQUIRES ITS DIRECTORS, CLINICAL MANAGERS, AND SELECTED PERSONNEL WHO HAVE SIGNIFICANT CONTACT WITH VENDORS AND CONTRACTORS TO ATTEST ANNUALLY THAT NEITHER HE/SHE, NOR ANY MEMBER OF HIS/HER IMMEDIATE FAMILY, HAVE A CONFLICT OF INTEREST WITH THE HOSPITAL. MEMBERS OF THE BOARD OF TRUSTEES, PRESIDENT & CEO, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS SIGN A SEPARATE, MORE DETAILED CONFLICT OF INTEREST STATEMENT. THE BOARD OF TRUSTEES OF PROVIDENCE HOSPITALS REQUIRES EACH MEMBER OF THE BOARD AND CORPORATE STAFF TO REVIEW THE HOSPITAL'S CONFLICT OF INTEREST POLICY AND TO DISCLOSE ALL INTERESTS THAT COULD RESULT IN A CONFLICT, ON AN ANNUAL BASIS. ALL DISCLOSURES ARE REPORTED TO THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE OF THE BOARD FOR REVIEW AND FOLLOW-UP, IF DETERMINED TO BE NECESSARY.
FORM 990, PART VI, SECTION B, LINE 15
THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. SPECIFICALLY, SECTION 2. ARTICLE IX: ADMINISTRATIVE OFFICERS OF THE AMENDED AND RESTATED BYLAWS OF SISTERS OF CHARITY PROVIDENCE HOSPITALS (PAGE 9) STATES: AN EVALUATION OF THE PERFORMANCE OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER SHALL BE CONDUCTED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE SHALL REPORT ITS EVALUATION TO THE BOARD OF TRUSTEES AND TO THE MEMBER. THE EXECUTIVE/COMPENSATION COMMITTEE IS CHAIRED BY THE CHAIR OF THE BOARD OF TRUSTEES. IT CONTAINS SIX OTHER BOARD MEMBERS. ALL COMPENSATION ISSUES ARE REVIEWED BY THIS COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION PROVIDES COPIES OF ITS FORM 990 AND RELATED SCHEDULES UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.
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 ITS OFFICE AND UPON REQUEST. ALL POLICIES ARE AVAILABLE TO ORGANIZATION EMPLOYEES VIA THE LOCAL INTRANET.
FORM 990, PART XI, LINE 9:
UNREALIZED GAIN ON FAIR VALUE OF INTEREST RATE SWAP 7,529,532. GAIN ON DISCONTINUED OPERATIONS 81,519.
FORM 990, PART XII, LINE 2C:
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART III, LINE 4A:
I. STATUS OF OUTREACH PROGRAMS: 1. DESCRIBE CURRENT OUTREACH ACTIVITIES. -HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY SCREENING FOR COLUMBIA AREA ATHLETES AS WELL AS CHESTER COUNTY SCHOOLS. -A HEALTH & WELLNESS STAFF MEMBER CONTINUES TO SERVE ON THE METRO BOARD FOR THE YMCA OF COLUMBIA. THIS BOARD OVERSEES 5 LOCAL YMCA BRANCHES. -REGULAR PARTICIPATION ON RICHLAND COUNTY HEALTH PARTNERS, A COMMUNITY GROUP THAT SHARES INFORMATION AND RESOURCES IN ORDER TO IMPACT THE GREATEST NUMBER OF COMMUNITY MEMBERS POSSIBLE. -A HEALTH & WELLNESS STAFF MEMBER SAT ON THE RACE COMMITTEE FOR THE PROVIDENCE HEART & SOLE WOMEN'S FIVE MILE RACE. THIS YEAR HAD THE GREATEST PARTICIPATION YET, AT OVER 2,200 PEOPLE. MEDICAL SERVICES AT THE EVENT WERE HELD AT THE EXPANDED CAPACITY THIS YEAR DUE TO OUR PARTICIPATION IN THE RACE COMMITTEE. MOORE CLINIC HANDLED THOSE SERVICES. -HEALTH & WELLNESS DEPARTMENT WORKED AT A COMMITTEE LEVEL FOR THE SC MISSION 2013: MIDLANDS TO PROVIDE FREE MEDICAL AND EYE CARE ON AUGUST 2 & 3, 2013 AT THE STATE FAIRGROUNDS. THE GOAL WAS TO MEET THE CRITICAL HEALTH CARE NEEDS OF PEOPLE IN THE COMMUNITY WHO ARE UNINSURED AND UNDERSERVED. THERE WERE MORE THAN 1,300 PATIENT INTERACTIONS AT THE SC MISSION 2013 ON FRIDAY AND SATURDAY. PATIENTS RECEIVED HEALTHCARE, EYE CARE, PRESCRIPTIONS AND WOMEN'S CARE, INCLUDING PAP SMEARS AND MAMMOGRAMS. THIS YEAR DENTAL WAS NOT OFFERED AT THE EVENT, WHICH WAS HELD AT THE SOUTH CAROLINA STATE FAIR GROUNDS. THE SC MISSION AIMS TO MEET THE NEEDS OF RESIDENTS WHO ARE UNDERSERVED AN UNINSURED. THERE WERE ABOUT 1,000 CLINICAL AND NON-CLINICAL VOLUNTEERS INCLUDING ABOUT 500 HEALTHCARE PROFESSIONALS SUCH AS DOCTORS, NURSES AND OPTOMETRISTS. TOTAL PATIENTS: MEDICAL PATIENTS: 600 EYE CARE PATIENTS: 589 EYEGLASSES: 537 MAMMOGRAM: 85 HIV TESTS: 49 PRESCRIPTIONS FILLED: 545 PAP SMEARS: 108 -PROVIDENCE COOKS-A HEART HEALTHY COOKING DEMONSTRATION PROGRAM- WAS ONCE AGAIN OFFERED TO THE COMMUNITY THIS YEAR. THIS PROGRAM IS A PARTNERSHIP BETWEEN DIETARYS HEAD CHEF AND HEALTH & WELLNESS'S REGISTERED DIETITIAN. THIS WAS A MAJOR SUCCESS! A TOTAL OF SEVEN CLASSES WERE HELD THIS YEAR WITH 157 PARTICIPANTS. -2013 EMPLOYEE WELLNESS PROGRAM ANNOUNCED. 8 HOURS OF PTO AND DISCOUNT ON INSURANCE PREMIUMS WERE USED AS INCENTIVES. 151 EMPLOYEES COMPLETED THE PROGRAM AND EARNED ADDITIONAL PTO. -CONTINUED THE COMMUNITY SUPPORTED AGRICULTURE PROGRAM FOR EMPLOYEES. ALSO ADDED A FRESH FRUIT AND VEGETABLE DELIVERY SERVICE TO PROVIDENCE, PROVIDENCE NE AND SCHC. -HEALTH & WELLNESS CONTINUED THE DIETITIAN ON DEMAND PROGRAM THAT ALLOWS COMMUNITY MEMBERS AND EMPLOYEES ACCESS TO A REGISTERED DIETITIAN ON A MINIMAL OR NO FEE BASIS. 220 PEOPLE WERE SEEN IN 2013. -16 SPEAKING OF YOUR HEALTH PROGRAMS WERE OFFERED WITH 300 PEOPLE ATTENDING. 2. WHAT ARE THE PLANS FOR THE COMING YEAR? OUR GOALS FOR 2014 INCLUDE: -EIGHT PROVIDENCE COOKS! PROGRAMS ARE SCHEDULED FOR 2014. -PLANS TO COORDINATE AND IMPLEMENT SC MISSION 2014: THE MIDLANDS; CONTINUE EMPHASIS ON MEDICAL HOMES AND SHIFTING PROGRAM TO A PERMANENT CLINIC WITH YEAR-ROUND SERVICES. -CONTINUE COMMUNITY EDUCATION OPPORTUNITIES LIKE SPEAKING OF YOUR HEALTH WITH AN EXPANSION OF THAT PROGRAM TO OUTLYING COMMUNITIES. -CURRENT EVALUATION OF CARDIOVASCULAR ULTRASOUND SCREENING EQUIPMENT TO DETERMINE ONGOING VASCULAR SCREENING PROGRAM. SECURED COMMITMENT FROM CHESTER HEALTHCARE FOUNDATION TO SCREEN CHESTER COUNTY ATHLETES IN MAY OF 2014. CARDIAC CLEARANCES FOR ATHLETES AS WELL AS CARDIAC SCREENINGS FOR ADULTS. -INCREASE EDUCATIONAL AND WELLNESS OPPORTUNITIES FOR OUR EMPLOYEES AND THEIR FAMILIES. 3. WAS THERE ANY COLLABORATIVE PLANNING WITH THE CATHOLIC DIOCESE? IF YES, PROVIDE EXAMPLES. NO COLLABORATIVE PLANNING WITH THE CATHOLIC DIOCESE TOOK PLACE IN 2013.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.