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.
| (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 | |||||||||
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. | ||||||
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). | ||||||






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.") . | 5,307 | 11,259 | 27,837 | 14,726 | 9,774 | 68,903 |
| 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...... | 17,824,090 | 17,724,614 | 17,894,748 | 18,547,193 | 19,921,840 | 91,912,485 |
| 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. | 17,829,397 | 17,735,873 | 17,922,585 | 18,561,919 | 19,931,614 | 91,981,388 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | 0 | 0 | 0 | 0 | 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 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support (Subtract line 7c from line 6.) | 91,981,388 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 17,829,397 | 17,735,873 | 17,922,585 | 18,561,919 | 19,931,614 | 91,981,388 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 259,321 | 246,954 | 277,937 | 313,740 | 316,223 | 1,414,175 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 259,321 | 246,954 | 277,937 | 313,740 | 316,223 | 1,414,175 |
| 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.) .. | 0 | 49,063 | 48,727 | 51,476 | 50,419 | 199,685 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 18,088,718 | 18,031,890 | 18,249,249 | 18,927,135 | 20,298,256 | 93,595,248 |




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 13000248 |
| Software Version: | 2013v3.1 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION | 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 4A, PROGRAM SERVICE DESCRIPTION | INTRODUCTION FRANCISCAN VILLA WAS FOUNDED IN 1966 AS A NON-PROFIT, LONG TERM CARE PROVIDER. FRANCISCAN VILLA'S CAMPUS IS COMPRISED OF A 150-BED NURSING HOME, A 64-UNIT MEMORY CARE ASSISTED LIVING FACILITY, A 39-UNIT FRAIL ELDERLY ASSISTED LIVING FACILITY, AND A 48-UNIT ASSISTED LIVING FACILITY SERVING THE NEEDS OF FRAIL ELDERLY AND MEMORY IMPAIRED RESIDENTS. THE ORGANIZATION ALSO PROVIDES CHILD DAY CARE SERVICES TO THE COMMUNITY. AS A TAX-EXEMPT 501(C)(3) LONG TERM CARE FACILITY, FRANCISCAN VILLA IS COMMITTED TO SERVING THE NEEDS OF COMMUNITY MEMBERS WITHOUT REGARD TO ONE'S ABILITY TO PAY. THE VILLA REQUIRES RESIDENTS TO DEMONSTRATE THE ABILITY TO PAY THE FACILITY FEES AND CHARGES, WHICH ARE SET AT A RATE THAT IS AFFORDABLE TO A SIGNIFICANT SEGMENT OF THE ELDERLY RESIDING IN THE AREA. HOWEVER, FRANCISCAN VILLA WILL NOT FORCE A RESIDENT TO MOVE FROM THE FACILITY IF THE INDIVIDUAL AND/OR THE INDIVIDUAL'S FAMILY BECOMES UNABLE TO PAY THE FACILITY CHARGES. FRANCISCAN VILLA IS ALSO COMMITTED TO THE PROMOTION OF HEALTHIER COMMUNITIES. FRANCISCAN VILLA IS PROUD OF ITS CATHOLIC HERITAGE AND ITS ABILITY TO PROVIDE DIRECT AND INDIRECT SUPPORT TO THE COMMUNITIES IT SERVES. IN TOTAL, OVER $1,871,000 IN QUANTIFIABLE COMMUNITY BENEFITS WERE PROVIDED DURING FY 2014. AS A PERCENT OF NET REVENUES, THIS EQUATES TO 9.4%. BENEFITS FOR THE POOR TRADITIONAL CHARITY CARE TRADITIONAL CHARITY CARE COSTS TOTALED OVER $9,000 DURING FY 2014. THREE (3) RESIDENTS QUALIFIED FOR BENEFITS UNDER THE ORGANIZATION'S CHARITY CARE POLICY, MOSTLY FOR BED HOLD DAYS NOT COVERED BY THE FAMILY CARE PROGRAM, A COUNTY-BASED MEDICAID-WAIVER PROGRAM. UNPAID COST OF MEDICAID AND OTHER SOCIAL PROGRAMS FRANCISCAN VILLA CONTINUES TO PROVIDE SERVICES TO MEDICAID AND FAMILY CARE RECIPIENTS WITHIN ITS SKILLED NURSING FACILITY. REIMBURSEMENT RATES UNDER THESE PROGRAMS FALL WELL SHORT OF THE ACTUAL COST OF PROVIDING CARE. THE $1,220,000 IN UNPAID COST OF SERVICES PROVIDED DURING THE YEAR REPRESENTS A SIGNIFICANT CONTRIBUTION TO THE COMMUNITY. OF THE TOTAL, MEDICAID ACCOUNTED FOR $718,000 AND FAMILY CARE REPRESENTED $502,000. NEARLY 35,000 DAYS OF SERVICE WERE PROVIDED TO MEDICAID AND FAMILY CARE RESIDENTS WITHIN THE NURSING HOME, REPRESENTING 67% OF TOTAL DAYS. SERVICES ARE ALSO PROVIDED TO FAMILY CARE RECIPIENTS WITHIN THE ORGANIZATION'S FRANCIS HOUSE CBRF, FRANCISCAN COURTS RCAC, AND FRANCISCAN GARDENS CBRF. REIMBURSEMENT RATES ARE INADEQUATE TO COVER THE FULL COST OF PROVIDING CARE. WITHIN THE FRANCIS HOUSE, $386,000 IN UNPAID COSTS WAS INCURRED; FAMILY CARE ACCOUNTED FOR 72% OF TOTAL DAYS WITHIN THIS FACILITY. A TOTAL OF $81,000 IN UNPAID COSTS WAS REPORTED WITHIN FRANCISCAN COURTS; FAMILY CARE REPRESENTED 75% OF THIS FACILITY'S TOTAL DAYS. AND AN ESTIMATED $165,000 IN UNPAID COSTS WAS INCURRED WITHIN THE FRANCISCAN GARDENS; FAMILY CARE RESIDENTS REPRESENTED 46% OF TOTAL DAYS. THE TOTAL OF UNPAID COST OF FAMILY CARE RECIPIENTS WITHIN THE ORGANIZATION'S ASSISTED LIVING FACILITIES EQUALED $632,000. OTHER SUPPORT FRANCISCAN VILLA COORDINATED ITS ANNUAL "CARING BY SHARING" PROGRAM. UNDER THIS INITIATIVE, EMPLOYEES SPONSORED 10 FAMILIES (ALL EMPLOYEES OF FRANCISCAN VILLA) AND PROVIDED THEM WITH CHRISTMAS GIFTS THAT THEY WOULD OTHERWISE NOT BE ABLE TO AFFORD. FRANCISCAN VILLA ALSO SPONSORED A "STUFF THE BUS" FOOD DRIVE, COLLECTING APPROXIMATELY 65 BOXES OF FOOD FROM EMPLOYEES AND COMMUNITY MEMBERS. ALL ITEMS WERE DELIVERED TO SOUTH MILWAUKEE HUMAN CONCERNS. TOTAL BENEFITS FOR THE POOR WERE $1,862,000 IN FY 2014. THIS REPRESENTS 9.4% OF TOTAL REVENUE. BENEFITS FOR THE BROADER COMMUNITY EDUCATIONAL SUPPORT SERVICES TO THE COMMUNITY EDUCATIONAL SUPPORT ACTIVITIES WERE CONTINUED DURING FY 2014, INCLUDING THE AWARDING OF SCHOLARSHIPS TO TWO AREA HIGH SCHOOL STUDENTS PURSUING A CAREER IN HEALTHCARE AND THE FREE USE OF ITS FACILITY BY A LOCAL COLLEGE AS A NURSING STUDENT CLINICAL ROTATION SITE. TRAINING AND EDUCATION WAS PROVIDED TO PROFESSIONALS AND COMMUNITY MEMBERS AT NO COST ON A VARIETY OF TOPICS: * COMMUNICATING BAD NEWS - FRANCISCAN VILLA OFFERED THIS PROGRAM TO SOCIAL WORKERS FOR CONTINUING EDUCATION. THE PROGRAM WAS PRESENTED BY REVEREND RUSSELL HURST, CHAPLAIN AT VITAS INNOVATIVE HOSPICE CARE. * OBSERVATION AND ASSESSMENT: FROM THE HOMECARE PERSPECTIVE - FRANCISCAN VILLA OFFERED THIS PROGRAM TO SOCIAL WORKERS FOR CONTINUING EDUCATION. THE PROGRAM WAS PRESENTED BY PATRICK TOPP, RN, MHSA. * END STAGE HEART DISEASE - THIS PROGRAM WAS OFFERED TO SOCIAL WORKERS FOR CONTINUING EDUCATION. THE PROGRAM WAS PRESENTED BY DR. MARILYN SINCABAN, MEDICAL DIRECTOR AT VITAS INNOVATIVE HOSPICE CARE. * VOLUNTEER CHAPLAIN PROGRAM - FRANCISCAN VILLA'S CHAPLAIN OFFERED THIS SIX-WEEK PROGRAM TO TRAIN COMMUNITY MEMBERS TO BECOME VOLUNTEER CHAPLAINS. ONGOING SUPPORT MEETINGS ARE ALSO HELD REGULARLY. OTHER SERVICES TO THE COMMUNITY FRANCISCAN VILLA AGAIN SPONSORED THE ANNUAL COOKIE DECORATING CONTEST, A POPULAR EVENT FOR CHILDREN AND FAMILIES AT HERITAGE DAYS, A SUMMER FUND-RAISING FESTIVAL OF THE LIONS CLUB IN SOUTH MILWAUKEE. ABOUT 100 CHILDREN PARTICIPATED. THE VILLA WAS A HOST SITE FOR INTERFAITH'S TRAVELING "LIFETIME ART SHOW". THE EXHIBITION FEATURES ARTWORK CREATED BY LOCAL ADULTS OF AT LEAST FIFTY YEARS OF AGE. THE ART SHOW WAS ON DISPLAY FOR A MONTH AND WAS OPEN TO THE COMMUNITY, INCLUDING AN OPENING RECEPTION. FRANCISCAN VILLA ALSO HOSTED A DINNER MEETING FOR THE SOUTH MILWAUKEE LION'S CLUB IN THE FRANCISCAN GARDENS CHAPEL. TOTAL BENEFITS FOR THE BROADER COMMUNITY WERE APPROXIMATELY $9,000 IN FY 2014. COMMUNITY BENEFITS SUMMARY FY 2014 COMMUNITY BENEFIT PROVIDED TO THE POOR: COST OF CHARITY CARE PROVIDED: 3 PEOPLE SERVED, $9,000 UNPAID COST OF MEDICAID: 122 PEOPLE SERVED, $718,000 UNPAID COST OF FAMILY CARE: 278 PEOPLE SERVED, $1,134,000 FINANCIAL CONTRIBUTIONS/OTHER: 10 PEOPLE SERVED, $1,000 COST OF COMMUNITY BENEFIT PROVIDED TO THE POOR: $1,862,000 COMMUNITY BENEFIT PROVIDED TO THE BROADER COMMUNITY: COMMUNITY EDUCATION: 87 PEOPLE SERVED $3,000 HEALTH PROFESSIONS EDUCATION: 26 PEOPLE SERVED, $2,000 COMMUNITY BUILDING ACTIVITIES: 130 PEOPLE SERVED, $4,000 TOTAL BENEFIT FOR THE BROADER COMMUNITY: $9,000 TOTAL COST OF COMMUNITY BENEFIT: $1,871,000 |
| Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee | PURSUANT TO SECTION 8.6 OF THE BYLAWS OF FRANCISCAN VILLA OF SOUTH MILWAUKEE, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, 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 FRANCISCAN VILLA OF SOUTH MILWAUKEE, THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES, A COLORADO 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 CATHOLIC HEALTH INITIATIVES ("CHI"). PURSUANT TO SECTION 5.4 OF 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 FRANCISCAN VILLA OF SOUTH MILWAUKEE *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE FRANCISCAN VILLA OF SOUTH MILWAUKEE *APPROVE MEMBERS OF THE FRANCISCAN VILLA OF SOUTH MILWAUKEE BOARD *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE FRANCISCAN VILLA OF SOUTH MILWAUKEE *APPROVAL OF ISSUANCE OF DEBT BY FRANCISCAN VILLA OF SOUTH MILWAUKEE *APPROVAL OF PARTICIPATION OF FRANCISCAN VILLA OF SOUTH MILWAUKEE IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY FRANCISCAN VILLA OF SOUTH MILWAUKEE *APPROVAL OF A MERGER INVOLVING THE FRANCISCAN VILLA OF SOUTH MILWAUKEE *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE FRANCISCAN VILLA OF SOUTH MILWAUKEE *TO REQUIRE THE TRANSFER OF ASSETS BY THE FRANCISCAN VILLA OF SOUTH MILWAUKEE TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR FRANCISCAN VILLA OF SOUTH MILWAUKEE PURSUANT TO SECTION 5.5.2 OF 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 | ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE TREASURER/EVP CFO. THE TREASURER/EVP CFO PRESENTS THE RETURN TO THE FRANCISCAN VILLA OF SOUTH MILWAUKEE'S BOARD AT A BOARD MEETING, OR AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL FOR THEIR REVIEW. SUBSEQUENT TO PROVIDING THE RETURN 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 | ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT. IN ADDITION, ANY BOARD MEMBER WITH A CONFLICT IS REQUIRED TO DECLARE THE CONFLICT BEFORE THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING. THE ENTIRE BOARD OR COMMITTEE DETERMINES WHETHER THE AFFECTED BOARD MEMBER SHOULD BE EXCLUDED FROM THE MEETING DUE TO THE DISCLOSED CONFLICT. |
| FORM 990, PART VI, LINE 14, DOCUMENT RETENTION AND DESTRUCTION POLICY | THE ORGANIZATION HAS A DOCUMENT RETENTION AND DESTRUCTION POLICY, HOWEVER, THE POLICY HAD NOT BEEN ADOPTED BY THE GOVERNING BOARD AS OF THE END OF THE TAX YEAR. |
| FORM 990, PART VI, LINE 15A, PROCESS OF DETERMINING COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL | THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CHI. 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, LINE 15B, PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES | THE PROCESS FOR DETERMINING THE COMPENSATION OF THE OTHER OFFICERS OR KEY EMPLOYEES WAS THE RESULT OF AN INDEPENDENT COMPENSATION STUDY CONDUCTED IN JANUARY 2011. THIS STUDY WAS THEN PRESENTED TO AND APPROVED BY THE BOARD IN NOVEMBER 2011. |
| 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.CATHOLICHEATHINIT.ORG OR AT WWW.DACBOND.COM. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT. IN ADDITION, THE GOVERNING DOCUMENTS ARE AVAILABLE FROM THE WISCONSIN SECRETARY OF STATE. |
| Form 990 , Part XI, Line 9, Other changes in net assets or fund balances | CAPITAL RESOURCE POOL CONTRIBTUTION - -77412; |
| Software ID: | 13000248 |
| Software Version: | 2013v3.1 |