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
CHI HEALTH CONNECT AT HOME - FARGO
Employer identification number
27-1966847
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.") .
236,208
550,297
235,212
250,354
1,272,071
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......
4,221,107
8,164,938
7,644,212
6,705,095
26,735,352
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
2,559
1,230,931
889,802
258,672
2,381,964
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.
0
4,459,874
9,946,166
8,769,226
7,214,121
30,389,387
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.)
30,389,387
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...
0
4,459,874
9,946,166
8,769,226
7,214,121
30,389,387
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
11
38
49
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
0
0
0
11
38
49
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
0
0
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
0
4,459,874
9,946,166
8,769,237
7,214,159
30,389,436
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
CHI HEALTH CONNECT AT HOME - FARGO
Employer identification number
27-1966847
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 3, Significant changes in program services
IN COORDINATION WITH THE SALE OF ST. MARY'S HOSPITAL IN PIERRE, SOUTH DAKOTA, TO AVERA HEALTH, OUR HOME HEALTH AND HOSPICE AGENCY LOCATED IN THAT COMMUNITY CEASED TO BE PART OF CHI HEALTH CONNECT AT HOME - FARGO AS OF 1/1/14, AND WE NO LONGER HAVE ANY BUSINESS OPERATIONS IN THE STATE OF SOUTH DAKOTA. WE ALSO DISCONTINUED MORE OF THE ANCILLARY BUSINESS LINES ASSOCIATED WITH THE APPLIED MEDICAL, INC. (AMI) PURCHASE FROM SEPTEMBER 2011; THE VOLUNTARY TERMINATION OF A SPEECH THERAPY STAFF IN SEPTEMBER 2013 BROUGHT ABOUT THE DISCONTINUATION OF ALL BUT ONE THIRD PARTY THERAPY CONTRACT FOR OUR ENTIRE BUSINESS ENTITY.
FORM 990, PART III, LINE 4A, STATEMENT OF PROGRAM SERVICES
IN FISCAL YEAR 2014, CHI HEALTH CONNECT AT HOME - FARGO'S TOTAL COMMUNITY BENEFIT WAS $18,626, SERVING 1,185 PEOPLE. FY14 WAS ANOTHER YEAR MARKED WITH CHANGES FOR OUR ORGANIZATION, AS OUR PIERRE, SOUTH DAKOTA, AGENCY MOVED ON FROM CATHOLIC HEALTH INITIATIVES (CHI) MID-YEAR, AND WE TRANSITIONED TO NEW LOCAL LEADERSHIP IN 3 OF THE 5 REMAINING AGENCY LOCATIONS. CHI HEALTH CONNECT AT HOME - FARGO HAS BEEN IN OPERATIONS AS A SEPARATE, STAND-ALONE HOME HEALTH AND HOSPICE BUSINESS FOR 3.5 YEARS, STARTING WITH 10 SEPARATE AGENCY LOCATIONS ACROSS ND, MN, AND SD. WITH THE TRANSITION OF OUR PIERRE LOCATION, FY14 OPERATIONS WERE REPRESENTATIVE AT YEAR END OF FIVE AGENCIES, INCLUDING TWO IN MN, OPERATED OUT OF ALBANY AND BRECKENRIDGE, AND THREE IN ND, WHICH WERE IN DICKINSON, WILLISTON, AND OUR LARGE CONSOLIDATED VALLEY CITY AGENCY. WE CONTINUE TO SERVE MORE THAN 1/3 OF THE STATE OF NORTH DAKOTA. FOR FY14, WE REPORTED COMMUNITY BENEFIT THROUGH CHARITY CARE IN NEARLY ALL OF OUR LOCATIONS, WITH THE MAJORITY OF BENEFITS PROVIDED IN THE AREAS OF COMMUNITY HEALTH EDUCATION WITH BEREAVEMENT SUPPORT GROUPS AND PROFESSIONAL HEALTH EDUCATION WITH NURSING STUDENTS. OUR PRIMARY BUSINESS OFFERINGS OF HOME HEALTH AND HOSPICE OFFER US A VARIETY OF OPPORTUNITIES AND VENUES IN OUR COMMUNITIES FOR PROVIDING BENEFITS TO HELP EDUCATE AND INCREASE AWARENESS. WE WILL CONTINUE TO EXPLORE ALL OF THOSE OPTIONS TO INSURE OUR ONGOING REPORTING IS REFLECTIVE OF ALL THAT WE DO. CHI HEALTH CONNECT AT HOME - FARGO IS A NONPROFIT, TAX EXEMPT FACILITY THAT TAKES ALL NECESSARY MEASURES TO BE COMPLIANT WITH ALL LEGISLATION IN HEALTH CARE REFORM IN DETERMINING WHAT TO REPORT AND HOW TO REPORT, AS WELL AS PUTTING AN INCREASED FOCUS ON WHAT EACH INDIVIDUAL COMMUNITY MAY NEED. WE CONTINUE TO STRATEGICALLY PLAN WITH OUR AGENCIES IN WILLISTON AND DICKINSON, WHO ARE AMIDST THE OIL EXPANSION BUSINESS IN WESTERN NORTH DAKOTA, TO BE SURE WE ARE ON PACE TO OFFER MORE AS THE POPULATION CONTINUES TO GROW AND DIVERSIFY. FY14 WAS ANOTHER YEAR OF TRANSITIONS FOR US, HOWEVER, WE ARE MORE ORGANIZATIONALLY AND FINANCIALLY STABLE THAN WE HAVE BEEN AND FEEL WE ARE IN A BETTER POSITION THAN EVER TO SEE OUR COMMUNITY BENEFITS INCREASE IN COMING YEARS.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
PURSUANT TO SECTION 8.4 OF THE BYLAWS OF CHI CONNECT AT HOME - FARGO, THE STANDING COMMITTEES OF THE BOARD OF DIRECTORS INCLUDES AN EXECUTIVE COMMITTEE AND SUCH OTHER STANDING COMMITTEES AS MAY BE ESTABLISHED BY THE BOARD OF DIRECTORS FROM TIME TO TIME. PURSUANT TO SECTION 8.2 OF THE BYLAWS OF CHI CONNECT AT HOME - FARGO, EACH COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION TO THE EXTENT PROVIDED IN RESOLUTION ESTABLISHING SUCH COMMITTEE. COMMITTEES ARE SUBJECT AT ALL TIMES TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS. ANY COMMITTEE COMPOSED OF PERSONS, ONE OR MORE OF WHOM ARE NOT DIRECTORS, SHALL ACT SOLELY IN AN ADVISORY CAPACITY TO THE BOARD. NO COMMITTEE OF THE BOARD SHALL HAVE AUTHORITY TO EXERCISE POWERS RESERVED TO THE CORPORATE MEMBER OR TO EXERCISE POWERS THAT CANNOT BE DELEGATED TO A COMMITTEE UNDER THE LAWS OF THE STATE OF MINNESOTA.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
PURSUANT TO SECTION 5.1 OF THE BYLAWS OF CHI HEALTH CONNECT AT HOME-FARGO, 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
PURSUANT 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. 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 EXECUTIVE 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 5.4.1 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 CHI HEALTH CONNECT AT HOME - FARGO; AMENDMENT OF THE CORPORATE DOCUMENTS OF CHI HEALTH CONNECT AT HOME - FARGO; APPROVE MEMBERS OF THE CHI HEALTH CONNECT AT HOME - FARGO BOARD; REMOVAL OF A MEMBER OF THE GOVERNING BODY OF CHI HEALTH CONNECT AT HOME - FARGO; APPROVAL OF ISSUANCE OF DEBT BY CHI HEALTH CONNECT AT HOME - FARGO; APPROVAL OF PARTICIPATION OF CHI HEALTH CONNECT AT HOME - FARGO IN A JOINT VENTURE; APPROVAL OF FORMATION OF A NEW CORPORATION BY CHI HEALTH CONNECT AT HOME - FARGO; APPROVAL OF A MERGER INVOLVING CHI HEALTH CONNECT AT HOME - FARGO; APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF CHI HEALTH CONNECT AT HOME - FARGO; TO REQUIRE THE TRANSFER OF ASSETS BY CHI HEALTH CONNECT AT HOME - FARGO TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR CHI HEALTH CONNECT AT HOME - FARGO. 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 EXECUTIVE DIRECTOR 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, IT IS PRESENTED TO THE BOARD AT A BOARD MEETING, OR AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL. SUBSEQUENTLY, 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
EACH EMPLOYEE MUST PROMPTLY AND FULLY REPORT TO THE EMPLOYEE'S DIRECT MANAGER OR SUPERVISOR ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST. THE EMPLOYEE MUST REPORT THE ACTUAL OR POTENTIAL CONFLICT AS SOON AS POSSIBLE AS THE EMPLOYEE BECOMES AWARE OF IT. IN ANY SITUATION WHERE THE EMPLOYEE MAY BE IN DOUBT, THE EMPLOYEE IS TO MAKE FULL DISCLOSURE SO AS TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION TO BE MADE. ANY QUESTION ABOUT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST SHOULD FIRST BE PRESENTED BY THE EMPLOYEE TO THE EMPLOYEE'S DIRECT MANAGER OR SUPERVISOR FOR REVIEW AND DETERMINATION. IF THE EMPLOYEE DOES NOT IDENTIFY OR RECOGNIZE THE CONFLICT OR THE NEED TO REQUEST A REVIEW, THE MANAGER, WHO BECOMES AWARE OF A SITUATION THAT INVOLVES THE EMPLOYEE AND PRESENTS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, SHOULD MAKE A DETERMINATION AND ADVISE THE EMPLOYEE OF THE SAME. AMONG THE FACTORS THAT SHOULD BE CONSIDERED IN DETERMINING WHETHER A CONFLICT EXISTS ARE THE NATURE AND MAGNITUDE OF THE OPPORTUNITY, TRANSACTION, OR ARRANGEMENT; THE DEGREE TO WHICH IT IS RELATED TO THE ORGANIZATION'S BUSINESS; WHETHER THE INDIVIDUAL WITH THE CONFLICT IS THE ULTIMATE DECISION MAKER OR HOLDS SIGNIFICANT INFLUENCE OVER THE ULTIMATE DECISION MAKER; THE UNIQUE NATURE OF THE OPPORTUNITY, TRANSACTION, OR ARRANGEMENT; THE EXISTENCE OF OTHER VIABLE ALTERNATIVES AND THE QUALITY OF THOSE ALTERNATIVES; AND WHAT IS CUSTOMARY AND REASONABLE IN THE HEALTH CARE INDUSTRY.
FORM 990, PART VI, LINE 14, DOCUMENT RETENTION AND DESTRUCTION POLICY
THE DOCUMENT RETENTION AND DESTRUCTION POLICY HAS NOT BEEN FORMALLY ADOPTED BY THE BOARD OF DIRECTORS. THE ORGANIZATION CURRENTLY ADHERES TO AN UNOFFICIAL POLICY, PENDING REVIEW AND BOARD APPROVAL.
FORM 990, PART VI, LINE 15, PROCESS USED TO ESTABLISH COMPENSATION
MARKET DATA FOR THE EXECUTIVE DIRECTOR, AS WELL AS OTHER KEY POSITIONS FOR THE ENTITY WAS GATHERED FROM MULTIPLE SALARY SURVEY SOURCES IN 2013. A REVIEW OF THE DATA AND A RECOMMENDATION WAS MADE BY THE DIRECTOR, HR BUSINESS PRACTICES TO THE DIVISION VICE PRESIDENT OF HUMAN RESOURCES. FINAL APPROVAL OF COMPENSATION WAS OBTAINED BY THE SENIOR VP OF THE FARGO OPERATING DIVISION. THESE DETERMINATIONS ARE REVIEWED BY HUMAN RESOURCES AND BROUGHT TO THE BOARD OF DIRECTORS, WHEREIN THEY HAVE AN OPPORTUNITY FOR QUESTIONS AND/OR TO EXPRESS ANY CONCERNS. THE ORGANIZATION'S EXECUTIVE DIRECTOR'S COMPENSATION WAS PREVIOUSLY 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.
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.
Form 990, Part IX, Line 11g, Other Expenses
PURCHASED SERVICES - TOTAL EXPENSE: 775409, PROGRAM SERVICE EXPENSE: 775409, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONTRACT SERVICES - NURSING - TOTAL EXPENSE: 274748, PROGRAM SERVICE EXPENSE: 274748, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CTONTRACTED THERAPY - TOTAL EXPENSE: 154809, PROGRAM SERVICE EXPENSE: 154809, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; OTHERE FEES FOR SERVICES - TOTAL EXPENSE: 200623, PROGRAM SERVICE EXPENSE: 70721, MANAGEMENT AND GENERAL EXPENSES: 129902, FUNDRAISING EXPENSES: ;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.