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 FRANCIS COMMUNITY HEALTH SERVICES
Employer identification number
99-0325194
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.") .
1,542,937
1,741,363
1,944,599
1,804,347
1,973,596
9,006,842
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......
20,573,984
25,454,054
26,940,547
24,274,049
19,611,446
116,854,080
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.
22,116,921
27,195,417
28,885,146
26,078,396
21,585,042
125,860,922
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
1,045,933
1,375,507
1,491,780
1,105,282
1,243,881
6,262,383
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..
1,045,933
1,375,507
1,491,780
1,105,282
1,243,881
6,262,383
8
Public support (Subtract line 7c from line 6.)
119,598,539
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...
22,116,921
27,195,417
28,885,146
26,078,396
21,585,042
125,860,922
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
41,326
120,807
36,604
52,141
70,542
321,420
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
41,326
120,807
36,604
52,141
70,542
321,420
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.)
..
1,019
2,028
39,799
834
3,940,924
3,984,604
13
Total support. (Add lines 9, 10c, 11, and 12.)..
22,159,266
27,318,252
28,961,549
26,131,371
25,596,508
130,166,946
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
91.881 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.090 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.247 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.190 %
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
ST FRANCIS COMMUNITY HEALTH SERVICES
Employer identification number
99-0325194
Return Reference
Explanation
FORM 990, PART I, LINE 1 AND PART III, LINE 1
ST. FRANCIS COMMUNITY HEALTH SERVICES (SFCHS), A SUBSIDIARY OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, PROVIDES COMMUNITY-BASED CARE TO MEET THE PHYSICAL, SPIRITUAL, AND PSYCHOSOCIAL NEEDS OF CLIENTS AND PATIENTS STATEWIDE. THE SISTERS OF ST. FRANCIS INTRODUCED MANY OF THESE FIRST-TO-MARKET HEALTHCARE PROGRAMS IN THE STATE OF HAWAII. AS PART OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, ST. FRANCIS COMMUNITY HEALTH 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. ST. FRANCIS COMMUNITY HEALTH SERVICES SERVES ALL THOSE IN NEED, INCLUDING THE MOST VULNERABLE, AND OFFERS CHARITY CARE FOR THOSE IN NEED OF FINANCIAL ASSISTANCE TO CARRY ON THE HEALTHCARE SYSTEM'S MISSION OF CREATING HEALTHY COMMUNITIES IN THE SPIRIT OF CHRIST'S HEALING MINISTRY.
FORM 990, PART III, Line 3
EFFECTIVE JUNE 30, 2014, ST. FRANCIS COMMUNITY HEALTH SERVICES TERMINATED ITS HOME CARE SERVICES PROGRAM AS PART OF ITS FUTURE PLAN TO FOCUS ON ITS EXISTING PROGRAMS AND TO THE DEVELOPMENT OF ADDITIONAL PROGRAMS IN PROVIDING SPECIALIZED NURSING CARE. OPERATING RESULTS FOR THE HOME CARE SERVICES PROGRAM ARE CLASSIFIED AS DISCONTINUED OPERATIONS IN PART VIII AND PART IX.
FORM 990, PART III, LINE 4A
FOR THE YEAR ENDED JUNE 30, 2014, ST. FRANCIS COMMUNITY HEALTH SERVICE'S INPATIENT HOSPICE FACILITY HAD AN AGGREGATE OF 11,700 IN-PATIENT DAYS; OUTPATIENT HOSPICE SERVICES HAD A TOTAL OF 66,400 OUTPATIENT DAYS. HOMECARE HAD A TOTAL OF 18,400 PATIENT VISITS. HEALTH SERVICES FOR SENIOR CITIZENS PROVIDED 28,700 BATHS FOR QUALIFIED SENIORS. ST. FRANCIS COMMUNITY HEALTH SERVICES INCLUDES ST. FRANCIS HOSPICE, THE FIRST AND LARGEST HOSPICE PROGRAM IN THE STATE ACCREDITED BY THE JOINT COMMISSION, OFFERING CARE FOR TERMINALLY ILL IN THEIR HOMES, TWO FREESTANDING, STATE-OF-THE-ART INPATIENT FACILITIES, AND IN NURSING HOMES THROUGHOUT THE COMMUNITY. ST. FRANCIS HOME CARE SERVICES, THE FIRST HOME CARE AGENCY IN THE STATE, PROVIDES TRANSITIONAL CARE TO PREVENT HOSPITALIZATION AND TO ENSURE PATIENTS DISCHARGED FROM HOSPITALS AVOID EMERGENCY ROOM VISITS OR READMISSIONS. ST. FRANCIS PALLIATIVE CARE, ONE OF THE NEWEST PROGRAMS, PROVIDES SPECIALIZED CARE TO ENSURE THE COMFORT OF THOSE UNDERGOING TREATMENT FOR SERIOUS ILLNESSES ON AN OUTPATIENT BASIS OR DURING VISITS TO NURSING HOMES. ST. FRANCIS HEALTH SERVICES FOR SENIOR CITIZENS PROVIDES A RANGE OF PERSONAL CARE SERVICES IN THE HOMES OF OAHU'S FRAIL ELDERS, INCLUDING A BATH, SHOWER AND SHAMPOO IN THEIR BED, TUB OR SHOWER; ROUTINE NAIL, SKIN AND HAIR CARE; ORAL CARE; SHAVING; AND CHANGE IN BED LINENS TO GIVE FAMILY CAREGIVERS A WELCOME BREAK. THIS KUPUNA PROJECT PROGRAM IS FUNDED BY THE CITY & COUNTY OF HONOLULU'S ELDERLY AFFAIRS DIVISION, STATE OF HAWAII'S EXECUTIVE OFFICE ON AGING, ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, AND GENEROUS DONORS.
FORM 990, PART VI, LINE 1A
PURSUANT TO THE BYLAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY TO BIND ST. FRANCIS COMMUNITY HEALTH SERVICES (CHS) IN ALL MATTERS RELATING TO THE REGULAR BUSINESS OF CHS DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS, AND WITH UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, LINE 6
THE SOLE CORPORATE MEMBER OF ST. FRANCIS COMMUNITY HEALTH 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 DIRECTORS OF ST. FRANCIS COMMUNITY HEALTH 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: A) ANY CHANGE IN THE PHILOSOPHY, MISSION, AND/OR PURPOSE OF THE CORPORATION; B) THE ADOPTION AND/OR AMENDMENT OF THE ARTICLES OF INCORPORATION; C) THE ADOPTION AND/OR AMENDMENT OF THE BYLAWS; D) THE APPOINTMENT OF DIRECTORS OF THE BOARD, AND REMOVAL OF DIRECTORS WITH OR WITHOUT CAUSE; E) APPOINT THE PRESIDENT OF THE CORPORATION; F) APPOINT THE CHIEF EXECUTIVE; G) APPROVE OR DISAPPROVE ANY SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS AND/OR SERVICES, OR ANY MERGER, CONSOLIDATION, REORGANIZATION, DIVESTING TRANSACTION OR ANY SIMILAR TRANSACTION REGARDING THE SAME, PLUS ALL OTHER ANCILLARY TRANSACTIONS NECESSARY OR APPROPRIATE TO CONSUMMATE THE SAME; H) THE DISSOLUTION OF THE CORPORATION AND DISPOSITION OF ASSETS; I) THE PURCHASE, SALE, LEASE OR MORTGAGE OF REAL PROPERTY; TO APPROVE THE PURCHASE, SALE, OR GIFT OF CAPITAL ASSETS; J) THE CORPORATION'S ANNUAL BUDGET, INCLUDING BUDGETS FOR OPERATIONS, CAPITAL EXPENDITURES, AND CASH FLOW.
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 THE 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 GOVERNMENT 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.