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
ST LUKE'S HEALTH SYSTEM
Employer identification number
76-0536232
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)
CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER
741161938
3
Yes
Yes
Yes
0
(B)
EPISCOPAL HEALTH FOUNDATION
760531710
9
Yes
Yes
Yes
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:
13000248
Software Version:
2013v3.1
-
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
ST LUKE'S HEALTH SYSTEM
Employer identification number
76-0536232
Return Reference
Explanation
Form 990, Part III, Line 3, Significant changes in program services
PLEASE REFER TO THE NARRATIVE PROVIDED ON FORM 990, PART III, LINES 3 AND 4A.
FORM 990, PART IV, LINE 12A, FORM 990, PART IV, LINES 12A & 12B
ST. LUKE'S HEALTH SYSTEM CORPORATION AND ITS RELATED ENTITIES WERE ACQUIRED BY CATHOLIC HEALTH INITIATIVES ("CHI"), A DENVER, COLORADO BASED NATIONAL HEALTHCARE ORGANIZATION, IN JUNE 2013. CHI ELECTED TO FORGO A SEPARATE AUDIT OF THE ST. LUKE'S HEALTH SYSTEM CORPORATION CONSOLIDATED GROUP FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2013. CHI'S FISCAL YEAR ENDS JUNE 30TH AND A CONSOLIDATED GROUP AUDIT (WHICH INCLUDED THE ST. LUKE'S HEALTH SYSTEM AND RELATED ENTITIES) WAS PERFORMED BY AN OUTSIDE AUDITING FIRM IN ACCORDANCE WITH GAAP FOR THE FISCAL YEAR ENDING JUNE 30, 2014.
FORM 990, PART V, LINE 2A, 990-PART V-LINE 2A
ST. LUKE'S EPISCOPAL HEALTH SYSTEM CORPORATION IS THE COMMON PAYMASTER FOR ITS RELATED EXEMPT ORGANIZATIONS. THE NUMBER OF EMPLOYEES REPORTED ON THIS RETURN REPRESENT THOSE WORKING IN ST. LUKE'S EPISCOPAL HEALTH SYSTEM CORPORATION DEPARTMENTS.
Form 990, Part VI, Sec A, Line 4, Significant changes to organizational documents
DURING 2013, ST. LUKE'S HEALTH SYSTEM AND ITS AFFILIATES WERE ACQUIRED BY CATHOLIC HEALTH INITIATIVES ("CHI"). PLEASE FIND UPDATED BY-LAWS (EFFECTIVE 6/1/2013) OF THE ST. LUKE'S HEALTH SYSTEM ATTACHED TO THIS FILING.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE SOLE CORPORATE MEMBER OF THE CORPORATION IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION (THE "CORPORATE MEMBER".)
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION SHALL BE VESTED IN A BOARD OF DIRECTORS, CONSISTING OF UP TO TWENTY-ONE (21) ELECTED MEMBERS, INCLUDING (A) THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION WHO SHALL BE AN EX OFFICIO MEMBER; (B) THE CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER, WHO SHALL BE AN EX OFFICIO MEMBER; AND (C) ONE (1) MEMBER OF THE BOARD OF TRUSTEES OF THE TEXAS HEART INSTITUTE, A TEXAS NON-PROFIT CORPORATION. ("THI")
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
THE ORGANIZATION'S CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES ("CHI"). PURSUANT TO THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX, THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: - SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE SAINT LUKE'S HEALTH SYSTEM ("SLHS") - AMENDMENT OF THE CORPORATE DOCUMENTS OF THE SLHS - APPROVE MEMBERS OF THE SLHS BOARD - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE SLHS.\ - APPROVAL OF ISSUANCE OF DEBT BY SLHS - APPROVAL OF PARTICIPATION OF SLHS IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY SLHS - APPROVAL OF A MERGER INVOLVING THE SLHS - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE SLHS - TO REQUIRE THE TRANSFER OF ASSETS BY THE SLHS TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR SLHS. PURSUANT TO THE ORGANIZATION'S BYLAWS, CHI MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
ST. LUKE'S HEALTH SYSTEM'S RETURN WAS PREPARED BY ITS TAX DEPARTMENT,UTILIZING INFORMATION PROVIDED BY ITS MANAGEMENT, OFFICERS, AND DIRECTORS. COLLABORATIVE REVIEW OF THE RETURN BY THE ORGANIZATION'S EXTERNAL ADVISERS, EXECUTIVE MANAGEMENT AND THE SLHS TAX DEPARTMENT WAS CONDUCTED, AND THE RETURN WAS MADE AVAILABLE TO THE OFFICERS AND DIRECTORS BEFORE FILING.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
PRIMARY MONITORING OF CONFLICT OF INTEREST IS DONE THROUGH ANNUAL POLLING OF OFFICERS, DIRECTORS, AND KEY EMPLOYEES FOR POTENTIAL CONFLICTS. CONFLICT OF INTEREST SUBMISSIONS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND SENIOR COUNSEL WHO BRING ACTIONABLE ITEMS TO THE BOARD. IF THE INSTITUTION DETERMINES THAT A SIGNIFICANT POSSIBILITY EXISTS THAT THERE IS A CONFLICT OF INTEREST, THE INDIVIDUALS INVOLVED WILL BE REQUIRED TO REFRAIN FROM MAKING A DECISION OR TAKING ANY ACTION UNTIL THE MATTER CAN BE FULLY INVESTIGATED AND A DECISION MADE AS TO WHETHER A CONFLICT EXISTS. IF A CONFLICT IS CONFIRMED, A PLAN FOR ALLEVIATING OR MANAGING THE CONFLICT IS IMPLEMENTED. INDIVIDUALS WITH POTENTIAL CONFLICTS MAY BE ASKED TO RECUSE AND ABSENT THEMSELVES FROM MEETINGS IN WHICH AN ALLEGED CONFLICT IS DISCUSSED IF SO DOING WOULD BETTER ASSURE THE INTEGRITY OF THE PROCESS.
FORM 990, PART VI, LINE 14, FORM 990, PART VI, LINE 14
A WRITTEN GENERAL POLICY RELATED TO DOCUMENT RETENTION AND DESTRUCTION. DOCUMENTS AND RECORDS ARE RETAINED FOR VARIOUS FEDERAL, STATE OR OTHER JURISDICTION STATUTES FOR MEDICAL OR FINANCIAL REVIEW ON A DEPARTMENT-BY-DEPARTMENT BASIS.
Form 990, Part VI, Sec B, Line 15a, Process to establish compensation of top management official
THE ORGANIZATION'S COMPENSATION COMMITTEE MEETS AS NEEDED, BUT TYPICALLY MEETS TWO TIMES PER YEAR. THIS COMMITTEE CONSISTS OF THREE OUTSIDE DIRECTORS. ITS FUNCTION IS TO MAKE RECOMMENDATIONS/DECISIONS ON SALARY AND BENEFITS FOR KEY EXECUTIVES. VARIOUS DATA ARE UTILIZED IN DECISION-MAKING INCLUDING COMPENSATION CONSULTANTS, MANAGEMENT'S LEVEL OF ACHIEVEMENT OF STIPULATED PERFORMANCE TARGETS, EXTERNAL SURVEYS, AND LOCAL MARKET CONDITIONS. PERMANENT MINUTES ARE PREPARED AND REVIEWED BY COMPENSATION COMMITTEE MEMBERS PRIOR TO THEIR RATIFICATION. THESE MINUTES ARE SUFFICIENTLY DETAILED TO PROVIDE SUBSTANTIATION OF THE DECISIONS MADE BY THE COMMITTEE WITH REGARD TO EACH KEY EXECUTIVE'S COMPENSATION AND BENEFITS. A REPORT IS MADE TO THE FULL BOARD BY THE COMPENSATION COMMITTEE CHAIR AT WHICH TIME RATIFICATION OF COMMITTEE ACTION IS VOTED BY THE BOARD.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees
THE ORGANIZATION'S COMPENSATION COMMITTEE MEETS AS NEEDED, BUT TYPICALLY MEETS TWO TIMES PER YEAR. THIS COMMITTEE CONSISTS OF THREE OUTSIDE DIRECTORS. ITS FUNCTION IS TO MAKE RECOMMENDATIONS/DECISIONS ON SALARY AND BENEFITS FOR KEY EXECUTIVES. VARIOUS DATA ARE UTILIZED IN DECISION-MAKING INCLUDING COMPENSATION CONSULTANTS, MANAGEMENT'S LEVEL OF ACHIEVEMENT OF STIPULATED PERFORMANCE TARGETS, EXTERNAL SURVEYS, AND LOCAL MARKET CONDITIONS. PERMANENT MINUTES ARE PREPARED AND REVIEWED BY COMPENSATION COMMITTEE MEMBERS PRIOR TO THEIR RATIFICATION. THESE MINUTES ARE SUFFICIENTLY DETAILED TO PROVIDE SUBSTANTIATION OF THE DECISIONS MADE BY THE COMMITTEE WITH REGARD TO EACH KEY EXECUTIVE'S COMPENSATION AND BENEFITS. A REPORT IS MADE TO THE FULL BOARD BY THE COMPENSATION COMMITTEE CHAIR AT WHICH TIME RATIFICATION OF COMMITTEE ACTION IS VOTED BY THE BOARD.
FORM 990, PART VI, LINE 16A, FORM 990, PART VI, LINES 16A & 16B
ST. LUKE'S HEALTH SYSTEM PARTICIPATES IN HOSPITAL JOINT VENTURES THROUGH SUBSIDIARY TAX EXEMPT ORGANIZATIONS THAT ARE A 51% CONTROLLING MEMBER OR PARTNER OF THE JOINT VENTURE. THE PARTNERSHIP AGREEMENTS/OPERATING AGREEMENTS OF EACH HOSPITAL JOINT VENTURES EXPRESSLY STATE THAT THE JOINT VENTURE WILL OPERATE AND CONDUCT ITS ACTIVITIES IN A MANNER THAT SATISFIES THE COMMUNITY BENEFIT STANDARD APPLICABLE TO TAX EXEMPT HEALTHCARE ORGANIZATIONS, AND THAT THIS COMMUNITY BENEFIT STANDARD SHALL TAKE PRECEDENCE OVER ANY OTHER FIDUCIARY DUTY. IN ADDITION, EACH PARTNERSHIP AGREEMENT/OPERATING AGREEMENT GIVES ST. LUKE'S THE ABILITY TO APPOINT A MAJORITY OF THE JOINT VENTURE'S GOVERNING BOARD. ACTIVITIES OF THE JOINT VENTURE ARE MONITORED THROUGH ST. LUKE'S MAJORITY PRESENCE ON THE JOINT VENTURE'S GOVERNING BOARD, WHO ARE EMPOWERED TO FORMULATE, IMPLEMENT, AND CONTROL THE CONTENT AND ADMINISTRATION OF THE CHARITY AND INDIGENT CARE POLICIES AND COMMUNITY BENEFIT POLICIES OF THE JOINT VENTURE.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
ST LUKES HEALTH SYSTEM CORPORATION AND ITS RELATED ENTITIES HAVE NOT CREATED A GENERAL POLICY PROVIDING FOR THE DISCLOSURE OF CERTAIN DOCUMENTS. IN PRACTICE, THESE DOCUMENTS HAVE BEEN MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST ONLY.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances
VALUATION ADJUSTMENT - 56144146; TRANSFER FROM CHI ST. LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER RESTRICTED FUND - XXX-XX-XXXX; CHI ST LUKES HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER PENSIONS & SWAPS - -XXX-XX-XXXX; TRANSFER FROM SLHS FDN RESTRICTED FUND - XXX-XX-XXXX;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.