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
SAINT FRANCIS MEDICAL CENTER FOUNDATION
Employer identification number
47-0630267
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.") ....
800,509
755,405
987,746
397,887
1,381,474
4,323,021
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
800,509
755,405
987,746
397,887
1,381,474
4,323,021
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)..
319,281
6
Public support. Subtract line 5 from line 4.
4,003,740
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..
800,509
755,405
987,746
397,887
1,381,474
4,323,021
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
321,306
315,595
318,673
369,018
657,019
1,981,611
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
73,000
87,776
92,966
113,512
108,341
475,595
11
Total support (Add lines 7 through 10).
6,780,227
12
Gross receipts from related activities, etc. (see instructions)
..................
12
166
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
59.050 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
53.400 %
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
SAINT FRANCIS MEDICAL CENTER FOUNDATION
Employer identification number
47-0630267
Return Reference
Explanation
FORM 990, PART III, LINE 1, PROGRAM SERVICE ACCOMPLISHMENTS
THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION.
FORM 990, PART III, LINE 4, PROGRAM SERVICE ACCOMPLISHMENTS
ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE THE SAINT FRANCIS MEDICAL CENTER FOUNDATION WAS INCORPORATED AS A 501(C)(3), TAX-EXEMPT, CHARITABLE FOUNDATION IN 1980 TO SERVE AS THE OFFICIAL GIFT-RECEIVING AND GIFT-ADMINISTRATION AGENCY FOR SAINT FRANCIS MEDICAL CENTER IN GRAND ISLAND, NEBRASKA. THE HEALTH CARE FOUNDATION WAS ESTABLISHED TO HELP FURTHER THE HOSPITAL'S MISSION OF PROVIDING HEALTH CARE SERVICES TO ALL IN NEED AND IMPROVE THE HEALTH OF THE COMMUNITIES THAT IT SERVES. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT THE SAINT FRANCIS MEDICAL CENTER FOUNDATION'S CURRENT STAFF AND VOLUNTEER BOARD OF DIRECTORS RAISE FUNDS THROUGH SPECIAL EVENTS, ANNUAL GIVING, MAJOR GIFTS, PLANNED GIVING, CORPORATE/FOUNDATION GRANTS, AND CAPITAL CAMPAIGNS TO HELP FUND MANY OF THE HEALTH CARE PROGRAMS, PROJECTS, AND COMMUNITY OUTREACH SERVICES OFFERED BY THE HOSPITAL. IN ADDITION, THE FOUNDATION PROVIDES FUNDING FOR NUMEROUS COMMUNITY-SPONSORED PROGRAMS THAT COMPLEMENT THE FOUNDATION'S MISSION AND WORK TOWARD THE CREATION OF HEALTHIER COMMUNITIES. IN FY14 THE SAINT FRANCIS MEDICAL CENTER FOUNDATION DISTRIBUTED $1,053,352 BACK INTO THE COMMUNITY THROUGH ITS FINANCIAL SUPPORT OF SAINT FRANCIS MEDICAL CENTER AND COMMUNITY-SPONSORED PROGRAMS. ADDITIONAL SUPPORT WAS PROVIDED THROUGH IN-KIND AND FIDUCIARY SUPPORT OF COMMUNITY PROJECTS. PROGRAMS SUPPORTED FINANCIALLY INCLUDED THE THIRD CITY COMMUNITY CLINIC, WHICH PROVIDES PRIMARY CARE AND DENTAL CARE TO LOW-INCOME RESIDENTS, SAINT FRANCIS CHILD SAFETY, WHICH PROMOTES USAGE OF CHILD SAFETY SEATS, AND THE STUDENT WELLNESS CENTER, WHICH PROVIDES PRIMARY HEALTH CARE SERVICES TO STUDENTS AT GRAND ISLAND SENIOR HIGH SCHOOL AND WALNUT MIDDLE SCHOOL. IN ADDITION, FUNDS SUPPORT PROJECT CARE, WHICH HELPS SAINT FRANCIS MEDICAL CENTER PATIENTS ADDRESS MEDICAL NEEDS THAT ARE NOT COVERED BY INSURANCE OR EXISTING PROGRAMS. THE FOUNDATION ALSO PROVIDED FUNDING FOR HIGH DOSE RADIATION TREATMENT EQUIPMENT FOR THE CANCER TREATMENT CENTER, INFANT SWADDLE SLEEPERS TO HELP PREVENT SIDS IN NEWBORN BABIES, MEDICATION DISPENSERS FOR PATIENTS USING THE LIFELINE ASSISTANCE PROGRAM, FUNDING FOR STUDENTS WHO ATTENDED THE STATE HEALTH OCCUPATION STUDENTS OF AMERICA CONFERENCE, AND EDUCATIONAL MATERIALS FOR CARDIAC REHAB PATIENTS.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
PURSUANT TO SECTION 8.6 OF THE BYLAWS OF SAINT FRANCIS MEDICAL CENTER FOUNDATION, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, AND THE PRESIDENT, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
ACCORDING TO THE BYLAWS OF SAINT FRANCIS MEDICAL CENTER FOUNDATION, THE ENTITY'S SOLE CORPORATE MEMBER IS SAINT FRANCIS MEDICAL CENTER, A NEBRASKA NONPROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
THE ORGANIZATION'S CORPORATE MEMBER IS SAINT FRANCIS MEDICAL CENTER. PURSUANT TO SECTION 5.3 OF THE ORGANIZATION'S BYLAWS, BOTH SAINT FRANCIS MEDICAL CENTER AND CATHOLIC HEALTH INITIATIVES (CHI) (SAINT FRANCIS MEDICAL CENTER'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE SAINT FRANCIS MEDICAL CENTER BOARD: APPROVE MEMBERS OF THE SAINT FRANCIS MEDICAL CENTER FOUNDATION BOARD; AMENDMENT OF THE CORPORATE DOCUMENTS OF SAINT FRANCIS MEDICAL CENTER FOUNDATION; APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF SAINT FRANCIS MEDICAL CENTER FOUNDATION; ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR SAINT FRANCIS MEDICAL CENTER FOUNDATION. 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 SAINT FRANCIS MEDICAL CENTER FOUNDATION; REMOVAL OF A MEMBER OF THE GOVERNING BODY OF SAINT FRANCIS MEDICAL CENTER FOUNDATION; APPROVAL OF ISSUANCE OF DEBT BY SAINT FRANCIS MEDICAL CENTER FOUNDATION; APPROVAL OF PARTICIPATION OF SAINT FRANCIS MEDICAL CENTER FOUNDATION IN A JOINT VENTURE; APPROVAL OF FORMATION OF A NEW CORPORATION BY SAINT FRANCIS MEDICAL CENTER FOUNDATION; APPROVAL OF A MERGER INVOLVING SAINT FRANCIS MEDICAL ENTER FOUNDATION; APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF SAINT FRANCIS MEDICAL CENTER FOUNDATION; TO REQUIRE THE TRANSFER OF ASSETS BY SAINT FRANCIS MEDICAL CENTER FOUNDATION TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.4.2 OF THE ORGANIZATION'S BYLAWS, SAINT FRANCIS MEDICAL CENTER OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE 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
THE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH THE CATHOLIC HEALTH INITIATIVES TAX DEPARTMENT TO PREPARE THE FORM 990, AND THE FINANCE STAFF CONSULTS WITH EXECUTIVE MANAGEMENT REGARDING THE ITEMS OF INTEREST I.E. CONFLICTS, POLITICAL ACTIVITIES, ETC. OF WHICH THEY WOULD HAVE FIRSTHAND KNOWLEDGE. AFTER COMPLETION OF THE FORM 990, A DRAFT COPY IS REVIEWED BY FINANCE AND EITHER THE DIRECTOR OF FINANCE OR CFO FOR ANY POTENTIAL ERRORS, OMISSIONS, OR CLARIFICATIONS NEEDED FOR PROPER PRESENTATION. AFTER FINAL CHANGES ARE MADE TO THE FORM 990, THE FINAL RETURN IS THEN PROVIDED TO THE BOARD MEMBERS PRIOR TO THE BOARD MEETING DATE. AT THE NEXT BOARD MEETING, THE FORM 990 IS AN AGENDA ITEM WHEREBY THE BOARD HAS AN OPPORTUNITY TO ASK QUESTIONS OR OBTAIN CLARIFICATION OF THE FORM 990 INFORMATION. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
SAINT FRANCIS MEDICAL CENTER FOUNDATION HAS A BOARD POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. AT THE ANNUAL BOARD AND BOARD COMMITTEE MEETINGS ALL MEMBERS ARE REQUESTED TO SIGN CONFLICT OF INTEREST STATEMENTS. THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE FILES. ALL MEMBERS ARE REQUESTED TO DECLARE POTENTIAL CONFLICTS OF INTEREST AT EACH BOARD AND/OR COMMITTEE MEETING. IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING. IN ADDITION, A QUESTIONNAIRE IS SENT ANNUALLY TO ALL BOARD MEMBERS AND TOP PAID EMPLOYEES ASKING THEM TO DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS.
FORM 990, PART VI, LINE 15A, PROCESS TO DETERMINE COMPENSATION OF TOP MANAGEMENT OFFICIAL
THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION IS PAID BY FRANCISCAN HEALTH SYSTEM (FHS), A RELATED ORGANIZATION. FHS USES AN EXTERNAL COMPENSATION FIRM WHO UTILIZES ACTUAL MARKET DATA COMPENSATION FROM SIMILAR INSTITUTIONS WITH COMPARABLE POSITIONS AND COMPENSATION LEVELS AND CONSIDERING THE ORGANIZATION'S GEOGRAPHIC LOCATION. THE EXECUTIVE COMMITTEE OF THE BOARD ANNUALLY EVALUATES AND APPROVES THE EXECUTIVE COMPENSATION ARRANGEMENT FOR EACH EXECUTIVE FOR FAIR MARKET VALUE ALONG WITH OTHER APPLICABLE FACTORS RELIED ON BY THE BOARD'S DETERMINATION. THE SUPPORTING DOCUMENTATION BECOMES PART OF THE MINUTES OF THE MEETING. THIS PROCESS IS COMPLETED YEARLY.
FORM 990, PART VI, LINE 15B, PROCESS TO DETERMINE COMPENSATION OF OTHER EMPLOYEES
DURING THE TAX YEAR ENDED 6-30-2014, NO OFFICERS, DIRECTORS, OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS, OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THIS QUESTION IS MORE APPROPRIATELY ANSWERED AS NA BUT HAS BEEN ANSWERED NO PER IRS INSTRUCTIONS.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC.
Form 990, Part IX, Line 11g, Other Expenses
OTHER FEES FOR SERVICES - TOTAL EXPENSE: 91747, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 4587, FUNDRAISING EXPENSES: 87160; COMPENSATION PAID BY RELATED ORGANIZATION - TOTAL EXPENSE: 236047, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 11802, FUNDRAISING EXPENSES: 224245;
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=GIFT CARDS/CERTIFICATES :
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=EVENT TICKETS :
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=MISCELLANEOUS ITEMS :
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=GIFT CARDS/CERTIFICATES :
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=EVENT TICKETS :
Schedule M, part I, column (b), Line other, Number of contributions or items contributed.
OTHER=MISCELLANEOUS ITEMS :
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.