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
Palm Healthcare Foundation Inc
Employer identification number
59-2391119
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.") ....
431,240
754,372
675,411
735,690
517,190
3,113,903
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
431,240
754,372
675,411
735,690
517,190
3,113,903
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.
3,113,903
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..
431,240
754,372
675,411
735,690
517,190
3,113,903
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
2,238,485
2,335,696
2,127,784
2,432,404
2,287,471
11,421,840
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.)..
10,000
10,000
11
Total support (Add lines 7 through 10).
14,545,743
12
Gross receipts from related activities, etc. (see instructions)
..................
12
393,892
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
21.410 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
25.590 %
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
Palm Healthcare Foundation's public support for fiscal year ended June 30, 2014 was 21.41%. The following facts and circumstances support the public charity status of the Foundation for three main reasons: 1) the Foundation's original corpus was funded substantially from broad public sources, and the high levels of investment income that impacts the public support percentage (Schedule A, Section C, Line 14) comes from that original public support; 2) the Foundation has always operated a comprehensive fund development program which solicits a broad range of public donors in a number of ways, includes major giving, annual giving, planned giving, grant-writing, special events and on-line giving; and 3) the Foundation's 15-member board of trustees and its eight (8) committees are made up of community members from a variety of geographic locations, industries, ethnic and religious backgrounds and socio-economic levels, representing Palm Beach County as a whole. 1) Palm Healthcare Foundation, a hospital conversion foundation, was created in July 2001 as the successor to the Good Samaritan Medical Center Foundation and St. Mary's Hospital Foundation when the two not-for-profit hospitals were sold to a for-profit entity. The funds in the hospital foundations, donated from a wide-range of public sources including individual donors, other foundations and corporations, formed the original corpus of Palm Healthcare Foundation. At the end of Palm Healthcare Foundation's first fiscal year, the Foundation held $64 million in assets, which was invested for the purposes of supporting the healthcare needs of Palm Beach County residents. From the beginning, the Foundation solicited the public at large for donations to supplement the corpus. Public donations and investment return has allowed Palm Healthcare Foundation to grant more than $63 million to more than 100 not-for-profit organizations serving the healthcare needs of our community. In recent years, the Foundation's work has been focused around and made significant advances in the critical issues of diabetes prevention and management, nursing advancement, family caregiving, and behavioral health.2) Since its inception, Palm Healthcare Foundation has maintained a continuous program for solicitation of funds from the general public, community and local sponsors. The Foundation employs a senior-level fund development executive who manages a comprehensive solicitation program, including:a. Three annual direct mail pieces are sent to thousands of community members.b. An annual giving program, Greater Together Giving Funds, which was supported by 100% of the Foundation's trustees this fiscal year.c. A yearly nursing appreciation reception with sponsorship opportunities.d. Corporate support for diabetes-related programming.e. Memorial and tribute giving opportunities. f. Multiple ways to give on-line at www.palmhealthcare.org.g. Fund raising ads are placed in the local newspaper.h. Annual reports with donors' stories and ways to give. i. Fund development training for trustees, as well as focus groups, cultivation activities and community events to which trustees bring potential donors. This fiscal year, 16 different sources donated $5,000 or more for a total of $160,814. When donors who gave smaller donations are included, the foundation received $318,568 from more than 300 donors altogether. These donors represent individuals, other foundations, corporations and other organizations from across Palm Beach County.3) Palm Healthcare Foundation's board of trustees consists of a strong, diverse governing body which represents the broad healthcare interests of the residents of Palm Beach County. Trustees represent the following sectors of the community:a. Health Care District (government).b. For-profit hospital.c. Local private physician practices.d. Nursing.e. Nursing education.f. Corporations.g. Small businesses. h. Legal field.i. Financial industry.j. Banking.k. Not-for-profit healthcare planning organization.l. Real Estate.m. Retired.In addition, Palm Healthcare Foundation owns and operates the Mollie Wilmot Children's Center at the Palm Healthcare Pavilion on the campus of St. Mary's Medical Center. Twenty-eight percent of the office space is provided free of charge to two unrelated not-for-profit organizations as part of the organization's mission to promote healthcare. The two not-for-profit organizations provide services directly for the benefit of the general public. The fair market value of the in-kind rent for the current fiscal year was $209,000. In light of the history of Palm Healthcare Foundation's public support origins and the ongoing commitment to soliciting public support to improve the health and well-being of residents of Palm Beach County, Palm Healthcare Foundation meets the facts and circumstances of the public support 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
Palm Healthcare Foundation Inc
Employer identification number
59-2391119
Return Reference
Explanation
Form 990, Part VI, Section B, line 11
The organzation makes its form 990 available to the board of directors by distributing a copy to each member of the board of trustees prior to filing with the IRS. The board reviews the content and discusses at a regularly scheduled board meeting. A motion is made to approve the filing of the form 990.
Form 990, Part VI, Section B, line 12c
The Foundation strictly adheres to the conflict of interest/disclosure policy. Pursuant to the policy, during discussion or debate at scheduled board committee meetings, trustees, employees and volunteers with real, perceived, or potential conflicts of interest must announce those conflicts to the attendees. Trustees, employees, and volunteers who have stated a potential conflict must abstain from the vote, vacate the room while the vote is taken and return after the vote has been decided. The action will be noted in the meeting minutes. Additionally, board members provide a conflict of interest/disclosure form annually in conjunction with the annual meeting.
Form 990, Part VI, Section B, line 15
The CEO and key employees compensation is reviewed annually and compared with similar non-profit positions from independent surveys. By recommendation of the executive committee, the board of trustees approves the CEO compensation. In addition, the board approves all employees compensation as detailed in the annual operating budget.
Form 990, Part VI, Section C, line 19
The organization makes its governing documents, conflict of interest policy, financial statements available upon request. The annual report is made available on the organization's website.
Part XII Line 2C
Audit Report Review Process: The audit report is reviewed annually at the audit report review meeting as presented by the independent auditors. The process has not changed from the prior year.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.