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
VILLA NAZARETH INC
Employer identification number
45-0226714
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.") .
253,592
216,635
625,788
147,172
112,238
1,355,425
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......
16,978,349
17,283,938
19,548,018
21,058,706
23,214,978
98,083,989
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.
17,231,941
17,500,573
20,173,806
21,205,878
23,327,216
99,439,414
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
6,225
0
0
6,225
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
6,225
0
0
6,225
8
Public support (Subtract line 7c from line 6.)
99,433,189
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...
17,231,941
17,500,573
20,173,806
21,205,878
23,327,216
99,439,414
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
77,461
74,206
88,740
88,928
92,929
422,264
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
77,461
74,206
88,740
88,928
92,929
422,264
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.)
..
829,853
980,630
927,410
981,608
983,503
4,703,004
13
Total support. (Add lines 9, 10c, 11, and 12.)..
18,139,255
18,555,409
21,189,956
22,276,414
24,403,648
104,564,682
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
95.090 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
94.860 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.400 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.420 %
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
VILLA NAZARETH INC
Employer identification number
45-0226714
Return Reference
Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS
I. INTRODUCTION VILLA NAZARETH, INC. OPERATES TWO DISTINCT PROGRAMS, 1) FRIENDSHIP, INC. AND 2) RIVERVIEW PLACE. FRIENDSHIP, INC.'S ORIGIN DATES BACK TO 1897 TO ST. JOHN'S ORPHANAGE. OVER THE YEARS THE NAME AND THE MISSION OF THE ORGANIZATION HAVE CHANGED TO MEET THE NEEDS OF THE COMMUNITY. IN 1981, VILLA NAZARETH (DBA FRIENDSHIP, INC.) WAS CREATED TO SERVE PEOPLE WITH DEVELOPMENTAL DISABILITIES IN A NON-INSTITUTIONAL, COMMUNITY-BASED PROGRAM. TODAY, FRIENDSHIP, INC. IS ONE OF THE LARGEST NON-PROFIT PRIVATE PROVIDERS OF COMMUNITY SERVICES TO PEOPLE WITH DEVELOPMENTAL DISABILITIES IN NORTH DAKOTA. OVER 260 PEOPLE WITH DEVELOPMENTAL DISABILITIES ARE SERVED BY FRIENDSHIP, INC. IN A VARIETY OF VOCATIONAL AND RESIDENTIAL PROGRAMS. VILLA NAZARETH (DBA RIVERVIEW PLACE) IS A RETIREMENT COMMUNITY FOR ADULTS 55 AND OLDER. RIVERVIEW PLACE WAS FORMED IN 1987 OFFERING 148 INDEPENDENT APARTMENT SETTINGS. AS SENIORS BEGAN TO AGE IN PLACE, AN ASSISTED LIVING PROGRAM WAS DEVELOPED AND APPROXIMATELY 50 OUT OF THE 148 APARTMENTS WERE DESIGNATED AS ASSISTED LIVING. A HEALTH SERVICE COMPONENT WAS ADDED TO ASSIST RESIDENTS WITH THEIR HEALTH CARE NEEDS. IN 2012 AN ENHANCED MEMORY CARE PROGRAM WAS STARTED IN RESPONSE TO THE MORE COMPREHENSIVE NEEDS OF RESIDENTS WITH MEMORY LOSS. AS OF THE END OF JUNE 2014, 12 APARTMENTS ARE AVAILABLE WITH THIS ENHANCED SERVICE AND 136 APARTMENTS ARE OFFERED AS INDEPENDENT OR ASSISTED LIVING. DURING THE FISCAL YEAR 2014, VILLA NAZARETH PROVIDED BENEFITS TO LOW INCOME INDIVIDUALS AND THE BROADER COMMUNITY OF $180,924 AS DESCRIBED BELOW. APPROXIMATELY 5,200 PEOPLE BENEFITED FROM THESE SERVICES. THE MAJOR COMPONENTS OF THESE COMMUNITY BENEFITS ARE AS FOLLOWS: BENEFITS FOR LOW INCOME INDIVIDUALS: COST OF CHARITY CARE: PERSONS SERVED - 6 COMMUNITY BENEFIT - $65,772 COMMUNITY SERVICE TARGETED FOR POOR: PERSONS SERVED - 506 COMMUNITY BENEFIT - $91,323 TOTAL BENEFITS FOR LOW INCOME INDIVIDUALS: PERSONS SERVED - 512 COMMUNITY BENEFIT - $157,095 BENEFITS FOR THE BROADER COMMUNITY: EDUCATION AND RESEARCH: PERSONS SERVED - 785 COMMUNITY BENEFIT - $10,888 OTHER COMMUNITY BENEFITS: PERSONS SERVED - 7,059 COMMUNITY BENEFIT - $12,941 TOTAL BENEFITS FOR BROADER COMMUNITY: PERSONS SERVED - 7,844 COMMUNITY BENEFIT - $23,829 TOTAL BENEFITS: PERSONS SERVED - 8,356 COMMUNITY BENEFIT - $180,924 II. BENEFITS FOR LOW INCOME INDIVIDUALS CHARITY CARE THE CHARITY CARE PROGRAM WAS IMPLEMENTED TO ALLOW SENIORS TO REMAIN AT RIVERVIEW PLACE AND RECEIVE NECESSARY SERVICES DESPITE THEIR SHRINKING ABILITY TO PAY FOR THE COSTS. AS SENIORS AGE AND LIFE EXPECTANCIES ARE EXCEEDED, A FEW OF OUR RESIDENTS FIND THEIR FINANCIAL MEANS CANNOT KEEP PACE WITH COSTS. IN FISCAL YEAR 2014, RIVERVIEW PLACE PROVIDED $65,772 TO SIX PEOPLE IN RENT EXPENSE THROUGH OUR CHARITY CARE PROGRAM. COMMUNITY SERVICE TARGETED FOR POOR AS REPRESENTATIVE PAYEE FOR 102 INDIVIDUALS SUPPORTED BY FRIENDSHIP, WE SET UP BANK ACCOUNTS AND ASSIST WITH, MONITOR AND RECONCILE THE MONTHLY ACTIVITY IN EACH ACCOUNT. FEES FOR THESE SERVICES WOULD ORDINARILY COST THE INDIVIDUALS APPROXIMATELY $40 PER MONTH PER ACCOUNT. FOR MANY OF THE PEOPLE SUPPORTED BY FRIENDSHIP, HOWEVER, INCOMES ARE LIMITED TO A LEVEL THAT COULD NOT SUPPORT THIS EXPENSE. FOR THIS REASON WE HAVE MADE A DECISION TO COVER THESE CHARGES. IN ADDITION, AND FOR THE SAME REASON, WE CHOSE NOT TO BILL 45 INDIVIDUALS IN OUR MINIMALLY SUPERVISED LIVING ARRANGEMENTS (MSLA) PROGRAM AN INCREASE IN CHARGES WHICH WAS DETERMINED TO BE OWED TO FRIENDSHIP UPON AUDIT BY THE STATE OF ND. THE COMBINED TOTAL FOR THESE SERVICES AMOUNTED TO $50,508 IN FISCAL YEAR 2014. AT FRIENDSHIP, FAMILY AND COMMUNITY LIVING (FCL) AND SUPPORTED EMPLOYMENT ARE TWO PROGRAMS THAT OFFER ASSISTANCE TO APPROXIMATELY 102 DISABLED INDIVIDUALS. THESE PROGRAMS ARE "MEDICAID WAIVERED" PROGRAMS. WE PRIDE OURSELVES ON SERVING PEOPLE WITH DEVELOPMENTAL DISABILITIES WHO ARE OF A MORE CHALLENGING NATURE. THE NEED TO SERVE THE MORE CHALLENGING PEOPLE IN THIS SETTING LEADS TO THE PROGRAM COSTS EXCEEDING REIMBURSEMENT LEVELS. IN FISCAL YEAR 2014, THE EXCESS COSTS WERE $25,941. SOME OTHER SITUATIONS OCCURRED DURING THE YEAR WHICH RESULTED IN PEOPLE SUPPORTED LOSING A JOB, ENCOUNTERING SIGNIFICANT CHANGES IN WAGES, OR DEVELOPING A NEED FOR MEDICAL EQUIPMENT THAT WAS NOT COVERED BY MEDICARE. AS A RESULT, SOME INDIVIDUALS SUPPORTED BY FRIENDSHIP COULD NOT AFFORD TO COVER THEIR NEEDS. THESE ARE WHAT WE CONSIDER EXTREME NEED SITUATIONS AND CERTAIN OF THESE EXPENSES WERE COVERED BY FRIENDSHIP INC. THIS YEAR $14,874 WAS SPENT TO ASSIST 224 PEOPLE SERVED UNDER OUR PROGRAMS. III. BENEFITS FOR THE BROADER COMMUNITY EDUCATION AND RESEARCH RIVERVIEW PLACE SERVES AS A HOST SITE FOR COMMUNIVERSITY, A PROGRAM OFFERING ENRICHING EDUCATIONAL OPPORTUNITIES FOR COMMUNITY MEMBERS. COMMUNIVERSITY HOSTED 10 SESSIONS OVER THE COURSE OF FISCAL YEAR 2014 WITH TOTAL ATTENDANCE OF APPROXIMATELY 225 PEOPLE AT THE COST OF $4,082. OTHER COMMUNITY EDUCATION PROGRAMS AT RIVERVIEW PLACE INCLUDE AARP-DRIVING SAFE PROGRAM, TOPS CLUB AND AQUA EXERCISE. THESE PROGRAMS ARE OPEN TO THE GREATER COMMUNITY AND ASSIST PEOPLE LIVING HEALTHY. 560 PEOPLE BENEFITTED FROM THESE PROGRAMS AT A COST OF $6,806. OTHER COMMUNITY BENEFITS RIVERVIEW PLACE CHAPEL IS OPEN FOR MEMBERS OF THE COMMUNITY TO ATTEND DAILY MASS AND ECUMENICAL SERVICES THROUGHOUT THE YEAR. 5,008 COMMUNITY MEMBERS ATTENDED SERVICES THIS PAST YEAR AT A COST OF $7,554. IN-KIND DONATIONS TO VARIOUS GROUPS TOTALED $5,387 FROM WHICH APPROXIMATELY 2,051 PEOPLE WERE IMPACTED. THESE INCLUDED ORGANIZATIONS SUCH AS UNITED WAY, ACCESS, THE NORTHERN PLAINS COUNCIL ON AGING AND DISABILITIES, AND THE NORTH DAKOTA ASSOCIATION OF COMMUNITY PROVIDERS.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
THE EXECUTIVE COMMITTEE CONSISTS ONLY OF DIRECTORS OF THE CORPORATION AND IS COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EACH OF WHOM SERVE AS EX OFFICIO VOTING MEMBERS OF THE EXECUTIVE COMMITTEE, AND TWO MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EXCEPT AS PROVIDED BY LAW, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE DOCUMENTED IN MINUTES AND PROMPTLY REPORTED TO THE BOARD AT THE NEXT EARLIEST MEETING.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE SOLE MEMBER OF THE ORGANIZATION IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
THE SOLE MEMBER HAS THE POWER TO APPOINT ORGANIZATION DIRECTORS, AND AFTER RECOMMENDATION BY THE BOARD OF DIRECTORS, MAY ACCEPT OR REJECT ANY INDIVIDUAL NOMINATED TO SERVE AS A DIRECTOR. THE SOLE MEMBER MAY ALSO UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS IF THE BOARD FAILS TO FURNISH A LIST OF QUALIFIED INDIVIDUALS TO SERVE.
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"). 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 VILLA NAZARETH, INC. - AMENDMENT OF THE CORPORATE DOCUMENTS OF VILLA NAZARETH, INC. - APPROVE MEMBERS OF THE VILLA NAZARETH, INC. BOARD - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF VILLA NAZARETH,INC. - APPROVAL OF ISSUANCE OF DEBT BY VILLA NAZARETH, INC. - APPROVAL OF PARTICIPATION OF VILLA NAZARETH, INC. IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY VILLA NAZARETH, INC. - APPROVAL OF A MERGER INVOLVING VILLA NAZARETH, INC. - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF VILLA NAZARETH, INC. - TO REQUIRE THE TRANSFER OF ASSETS BY VILLA NAZARETH, INC. TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. - ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR VILLA NAZARETH, INC. 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
THE RETURN IS PREPARED/COMPILED BY CHI'S TAX DEPARTMENT. ONCE COMPLETED IT IS REVIEWED BY THE ORGANIZATION'S FINANCE, AUDIT AND COMPLIANCE (FAC) COMMITTEE., THE CONTROLLER/TREASURER WILL REVIEW ANY SIGNIFICANT AND/OR UNUSUAL ITEMS AND WILL FIELD ANY QUESTIONS AT THE FAC MEETING. THE FAC COMMITTEE WILL THEN VOTE TO RECOMMEND APPROVAL OF THE RETURN TO THE FULL BOARD. AN ELECTRONIC COPY OF THE RETURN IS THEN IS SENT TO EACH BOARD MEMBER FOR THEIR REVIEW TO APPROVE. THE RETURN IS THEN FILED WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES BY CHI, 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
THE CONFLICT OF INTEREST POLICY IS COVERED IN "OUR VALUES AND ETHICS AT WORK" BOOKLET WHICH ALL EMPLOYEES RECEIVE AND ACKNOWLEDGE BY SIGNING THE CERTIFICATION WHICH IS PART OF THE BOOKLET. THEY ALSO PARTICIPATE IN AN ANNUAL LEARNING COURSE ABOUT THE TOPIC. ALL BOARD MEMBERS MUST SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. WHEN CONFLICTS OF INTEREST ARE CONSIDERED BY THE BOARD, THE DIRECTOR OR OFFICER MUST DISCLOSE ALL OF THE MATERIAL FACTS TO THE BOARD. THE DIRECTOR OR OFFICER DOES NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. HOWEVER, IF REQUESTED, SUCH DIRECTOR OR OFFICER IS NOT PREVENTED FROM BRIEFLY STATING HIS OR HER POSITION IN THE MATTER, NOR FROM ANSWERING PERTINENT QUESTIONS FROM BOARD MEMBERS, AS HIS OR HER KNOWLEDGE MAY BE OF SIGNIFICANT IMPORTANCE. THE DIRECTOR OR OFFICER SHALL BE EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST.
FORM 990, PART VI, LINE 15A, COMPENSATION OF TOP MANAGEMENT OFFICIAL
THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI HAS A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USES THE HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE HAY GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS DELIVERED BY HAY GROUP TO THE HR COMMITTEE OF THE CHI BOARD OF STEWARDSHIP TRUSTEES ANNUALLY AT THEIR SEPTEMBER MEETING AND MINUTES ARE SHARED WITH THE FULL BOARD AT THE DECEMBER MEETING. THE LAST REVIEW WAS SEPTEMBER 18, 2014. IN ADDITION, IN DECEMBER 2009, HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS. THESE LEVELS HAVE BEEN REVIEWED ANNUALLY SINCE AND REVISED BASED ON MARKET DATA, WHERE APPLICABLE.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees
THE CEO OF THE MBO DOES A MARKET STUDY TO DETERMINE IF THE SALARIES OF THE SENIOR MANAGEMENT TEAM ARE COMPARABLE. THIS MARKET STUDY IS SHARED WITH THE CEO OF THE FARGO DIVISION AND A SALARY RANGE IS SET FOR EACH POSITION. THIS RANGE IS ADJUSTED ANNUALLY BASED ON THE APPROVED PERCENTAGE INCREASE OF THE MEDICAID BUDGET AS SET BY THE STATE OF NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES. THIS PERCENTAGE ADJUSTMENT IS KEEPING THE SENIOR MANAGEMENT'S SALARY RANGE MARKETABLE. IN ADDITION, THE DIVISION OFFICE OF CHI IN FARGO AND THE COMPENSATION COMMITTEE OF THE BOARD ALSO REVIEW AND APPROVE THE SALARY RANGES OF THE SENIOR MANAGEMENT TEAM. THE REVIEW AND APPROVAL OF OTHER OFFICERS' COMPENSATION WAS LAST PERFORMED IN OCTOBER 2012.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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.ORG. ADDITIONALLY, THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE ON THE NORTH DAKOTA SECRETARY OF STATE'S WEBSITE.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances
CHI CONNECT DEPRECIATION - -9455;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.