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
FRANCISCAN CARE SERVICES
Employer identification number
27-4348363
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.") .
0
9,987
647,849
54,214
55,769
767,819
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......
180,396
417,148
967,817
1,797,422
3,362,783
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
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.
0
190,383
1,064,997
1,022,031
1,853,191
4,130,602
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
4,130,602
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...
0
190,383
1,064,997
1,022,031
1,853,191
4,130,602
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
14
4,895
762
3,118
8,789
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
14
4,895
762
3,118
8,789
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
11,398
4,283
15,681
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
0
190,397
1,069,892
1,034,191
1,860,592
4,155,072
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
0 %
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
FRANCISCAN CARE SERVICES
Employer identification number
27-4348363
Return Reference
Explanation
FORM 990, PART I, LINE 1 AND PART III, LINE 1
FRANCISCAN CARE SERVICES, AN ENTITY OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, WAS ESTABLISHED IN 2011 TO MEET THE RAPIDLY GROWING NEEDS OF HAWAII'S RAPIDLY GROWING OLDER ADULT POPULATION AND THE CORRESPONDING NEEDS OF FAMILY CAREGIVERS. FRANCISCAN CARE SERVICES CURRENTLY INCLUDES THE FRANCISCAN ADULT DAY CENTER IN MANOA, ALSO KNOWN AS THE SISTER MAUREEN INTERGENERATIONAL LEARNING ENVIRONMENT (SMILE), THE ST. FRANCIS INTERGENERATIONAL CENTER IN EWA VILLAGES AND PROVIDING MANAGEMENT/CARE SERVICES FOR A PRIVATE CARE HOME IN MANOA FOR THE SISTER OF ST FRANCIS. IN THE SPRING OF 2013, THE ST. FRANCIS INTERGENERATIONAL CENTER IN EWA VILLAGES, OPENED AND FEATURES A MONTESSORI-BASED PRESCHOOL AND ADULT DAY CARE UNDER ONE ROOF, AND IS MODELED AFTER THE SUCCESSFUL FRANCISCAN ADULT DAY CENTER IN MANOA.
FORM 990, PART III, LINE 4A
THE FRANCISCAN ADULT DAY CENTER PROVIDES ASSISTANCE WITH ACTIVITIES FOR DAILY LIVING AND PERSONAL CARE FOR OLDER ADULTS AND THOSE WITH DISABILITIES WHO NEED SPECIAL ATTENTION IN A SAFE ENVIRONMENT. THE PARTICIPANTS (33 ENROLLED AT THE END OF FISCAL 2013) ENJOY ARTS AND CRAFTS, EXERCISE, GAMES, AND MAKE NEW FRIENDS. CHILDREN FROM NEARBY SCHOOLS PARTICIPATE IN THE ACTIVITIES, CREATING POSITIVE MUTUALLY BENEFICIAL EXPERIENCES. THE SERVICE PROVIDES PEACE OF MIND FOR OLDER ADULTS WHOSE CAREGIVERS WORK DURING THE DAY AND ARE NOT ABLE TO BE AT HOME OR ARE IN NEED OF RESPITE. IN ADDITION, IN THE SPRING OF 2013, THE ST. FRANCIS INTERGENERATIONAL CENTER IN EWA VILLAGES, OPENED AND FEATURES A MONTESSORI-BASED PRESCHOOL AND ADULT DAY CARE UNDER ONE ROOF, AND IS MODELED AFTER THE SUCCESSFUL FRANCISCAN ADULT DAY CENTER IN MANOA. AS PART OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, FRANCISCAN CARE SERVICES CARRIES ON THE LEGACY OF ST. MARIANNE COPE AND THE SISTERS OF ST. FRANCIS, WHO CAME TO THE ISLANDS IN 1883 TO CARE FOR THOSE AFFLICTED WITH HANSEN'S DISEASE.
FORM 990, PART V, LINE 2A; PART VII, SECTION A; AND PART IX
FRANCISCAN CARE SERVICES DOES NOT HAVE EMPLOYEES BUT SHARES THE COSTS OF PERSONNEL, SERVICES, FACILITIES AND EXPENSES WITH ITS PARENT, ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII.
FORM 990, PART VI, LINE 1A
ALL OF THE POWERS, AUTHORITY, RIGHTS, AND DUTIES ACCORDED TO THE BOARD OF DIRECTORS OF THE CORPORATION UNDER THE ARTICLES OF INCORPORATION, AS SO AMENDED, THE BYLAWS, AS SO AMENDED, AND THE HAWAII NONPROFIT CORPORATIONS ACT SHALL BE DELEGATED TO THE BOARD OF DIRECTORS OF ST. FRANCIS HEALTHCARE SYSTEM (SFHSH) OF HAWAII SO THAT THE BOARD OF DIRECTORS OF SFHSH SHALL MANAGE EXCLUSIVELY THE CORPORATION'S BUSINESS AND AFFAIRS; AND FURTHER, THAT ANY OFFICER OF THE CORPORATION, ACTING ALONE OR TOGETHER WITH ANY OTHER OFFICER OF THE CORPORATION, IS AUTHORIZED, EMPOWERED AND DIRECTED, ON BEHALF OF THE CORPORATION AND IN ITS NAME, TO EXECUTE ANY APPLICATIONS, CERTIFICATES, AGREEMENTS OR ANY OTHER INSTRUMENTS OR DOCUMENTS OR AMENDMENTS OR SUPPLEMENTS THERETO, AND TO DO AND CAUSE TO BE DONE ANY AND ALL OTHER ACTS AND THINGS AS SUCH OFFICERS MAY IN THEIR DISCRETION DEEM NECESSARY, APPROPRIATE OR HELPFUL TO CARRY OUT THE PURPOSE AND EFFECT THE INTENT OF ANY OF THE FOREGOING RESOLUTIONS, THE EXECUTION AND DELIVERY THEREOF BY EACH SUCH OFFICER OR THE TAKING OF EACH SUCH ACT TO BE CONCLUSIVE EVIDENCE OF THE NECESSITY OR APPROPRIATENESS THEREOF.
FORM 990, PART VI, LINE 6
THE SOLE CORPORATE MEMBER OF FRANCISCAN CARE SERVICES IS ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII.
FORM 990, PART VI, LINE 7A
ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, AS THE SOLE CORPORATE MEMBER, APPROVES THE APPOINTMENT OF THE BOARD OF DIRECTORS OF FRANCISCAN CARE SERVICES.
FORM 990, PART VI, LINE 7B
ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, AS THE SOLE CORPORATE MEMBER, HAS THE FOLLOWING POWERS RESERVED TO APPROVE THE FOLLOWING: THE GENERAL POWERS GRANTED TO THE BOARD OF DIRECTORS ARE LIMITED OR RESTRICTED TO THE EXTENT THAT CERTAIN ACTIONS OF THE CORPORATION REQUIRE THE APPROVAL AND CONSENT OF THE SOLE MEMBER AS FOLLOWS: (A) APPROVAL OF THE CORPORATION'S ANNUAL BUDGET, INCLUDING BUDGETS FOR OPERATIONS, CAPITAL EXPENDITURES, AND CASH FLOW; (B) APPROVAL OF THE APPOINTMENT OF THE CHIEF OPERATING OFFICER OF THE CORPORATION; (C) ANY CHANGE IN PURPOSE, PHILOSOPHY OR OBJECTIVES OF THE CORPORATION; (D) FINAL DECISION ON THE NUMBER OF DIRECTORS CONSTITUTING THE ENTIRE BOARD OF DIRECTORS AND THE APPOINTMENT OR REMOVAL OF ANY MEMBER(S) AND ELECTED OFFICER(S) OF THE BOARD OF DIRECTORS; (E) ANY LOANS OR EVIDENCES OF INDEBTEDNESS WHICH ARE SECURED BY OR AFFECT THE REAL PROPERTY AND/OR ASSETS OF THE CORPORATION OR OF THE SOLE MEMBER OR THE SOLE MEMBER'S SUBSIDIARY CORPORATIONS AND CONTRACTED ON BEHALF OF THE CORPORATION; AND (F) AMENDMENT OF THE ARTICLES OF INCORPORATION AND/OR THESE BYLAWS OF THE CORPORATION.
FORM 990, PART VI, LINE 11B
THE FORM 990 AND SUPPORTING WORKPAPERS WERE REVIEWED BY THE CHIEF FINANCIAL OFFICER OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII AND THE COMPANY'S TAX ADVISORS, ERNST & YOUNG, LLP. A COPY OF FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, LINES 12A, 13 AND 14 AS OF JUNE 30, 2014, THE POLICIES IDENTIFIED IN PART VI WERE NOT FORMALLY ADOPTED BY THE ORGANIZATION. ALTHOUGH THE POLICIES HAVE NOT BEEN FORMALLY ADOPTED THE ORGANIZATION HAS BEEN FOLLOWING THEM.
FORM 990, PART VI, LINE 12C
A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED PRIOR TO EMPLOYMENT FOR ALL EMPLOYEES AND DIRECTORS. CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY HR PERSONNEL AND UPDATED ON AN ANNUAL BASIS. AFTER REVIEW BY HR PERSONNEL, POTENTIAL CONCERNS ARE REFERRED TO MANAGEMENT PERSONNEL AND RECOMMENDATIONS FOR RESOLUTIONS OF CONFLICTS ARE REFERRED TO THE CORPORATE COMPLIANCE STEERING COMMITTEE. IF A POTENTIAL OR IDENTIFIED CONFLICT OF INTEREST CANNOT BE RESOLVED BY THE AFOREMENTIONED COMMITTEE, THE MATTER WILL BE REFERRED TO THE ORGANIZATIONAL ETHICS COMMITTEE FOR ADVICE AND RECOMMENDATION.
FORM 990, PART VI, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE GENERAL PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.