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 HOME
Employer identification number
41-0729978
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.") .
16,412
57,492
335
5,660
1,816
81,715
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......
8,168,231
8,078,120
7,967,275
7,741,692
6,469,295
38,424,613
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.
8,184,643
8,135,612
7,967,610
7,747,352
6,471,111
38,506,328
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.)
38,506,328
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...
8,184,643
8,135,612
7,967,610
7,747,352
6,471,111
38,506,328
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
152,560
145,129
166,861
192,765
189,213
846,528
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
152,560
145,129
166,861
192,765
189,213
846,528
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.)
..
179,906
181,368
179,550
182,610
164,742
888,176
13
Total support. (Add lines 9, 10c, 11, and 12.)..
8,517,109
8,462,109
8,314,021
8,122,727
6,825,066
40,241,032
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
95.680 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
95.900 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.100 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.930 %
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
ST FRANCIS HOME
Employer identification number
41-0729978
Return Reference
Explanation
FORM 990, PART III, LINE 1, MISSION STATEMENT
ST. FRANCIS HOME AND CHI'S MISSION 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, STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
I. INTRODUCTION ST. FRANCIS HOME WAS ESTABLISHED IN SEPTEMBER 1952 AS A NON-PROFIT, LONG TERM CARE PROVIDER. THIS 120-BED SKILLED NURSING FACILITY SPECIALIZES IN PROVIDING AN INDIVIDUALIZED, HOME-LIKE ATMOSPHERE FOR THE RESIDENTS. UNITS ARE BROKEN INTO 20-BED NEIGHBORHOODS, WITH SEPARATE KITCHENS, DINING AREAS, LIVING ROOMS, LAUNDRY FACILITIES, ETC. RESIDENTS CAN CHOOSE TO GET UP WHEN THEY WANT TO AND CAN ORDER WHAT THEY WANT FOR BREAKFAST. ST. FRANCIS ALSO OFFERS INTER-GENERATIONAL ACTIVITIES FOR THE RESIDENTS AND YOUTH IN THE COMMUNITY. THE MISSION OF ST. FRANCIS HOME IS TO CARE FOR THE FRAIL ELDERLY MEMBERS OF OUR COMMUNITY WITH DIGNITY AND TO ADVOCATE FOR THEIR HEALTH CARE NEEDS. DURING FISCAL YEAR 2014, ST. FRANCIS HOME PUT 40 OF THE 120 LICENSED BEDS ON LAY-AWAY DUE TO DIFFICULTIES IN RECRUITING ADEQUATE STAFFING TO MAINTAIN SAFE QUALITY CARE. THE LAST HALF OF THE YEAR, THE OPERATIONS WERE RESTRICTED TO 80 BEDS. AS A TAX-EXEMPT 501(C)(3) LONG TERM CARE FACILITY, ST. FRANCIS HOME IS COMMITTED TO SERVING THE NEEDS OF COMMUNITY. ST. FRANCIS HOME REQUIRES THE RESIDENTS TO DEMONSTRATE THE ABILITY TO PAY THE FACILITY FEES AND CHARGES, WHICH ARE SET BY THE STATE OF MINNESOTA, BUT WILL ASSIST IN LOCATING PAYER SOURCES THE RESIDENT MAY BE ELIGIBLE FOR. ALL RESIDENTS ARE CHARGED THE SAME RATES, BASED ON THEIR CARE LEVELS, REGARDLESS OF THEIR PAYER SOURCE. THE 9-MEMBER, VOLUNTEER, BOARD OF DIRECTORS LEADS ST. FRANCIS HOME'S COMMITMENT TO PROMOTE THE DEVELOPMENT OF HEALTHIER COMMUNITIES, ESPECIALLY AS IT CONCERNS OUR SENIOR CITIZENS. ST. FRANCIS HOME IS PROUD OF ITS CATHOLIC HERITAGE AND ITS ABILITY TO PROVIDE DIRECT AND INDIRECT SUPPORT TO THE COMMUNITIES IT SERVES. SINCE THE 1980'S, ST. FRANCIS HOME HAS BEEN ACTIVELY INVOLVED WITH ITS SISTER CORPORATION, ST. FRANCIS MEDICAL CENTER, WITH COMMUNITY HEALTH COLLABORATION. SEVERAL TIMES, ST. FRANCIS HAS TAKEN THE LEAD IN ORGANIZING COMMUNITY TEAMS AND FOCUS GROUPS TO LOOK AT HEALTH ISSUES, SET PRIORITIES AND PLANS FOR IMPROVEMENT. THAT COMMITMENT CONTINUES TODAY WITH ST. FRANCIS' MEMBERSHIP ON THE RICHLAND-WILKIN HEALTHY COMMUNITIES, INC. BOARD OF DIRECTORS, AS WELL AS OTHER COMMUNITY GROUPS. ST. FRANCIS COMMUNITY BENEFIT PLAN HAS BEEN ESTABLISHED IN CONJUNCTION WITH ITS SISTER CORPORATIONS OF ST. FRANCIS MEDICAL CENTER, APPLETREE COURT, AND THE HEALTHCARE AND WELLNESS FOUNDATION. THE PLAN IS BASED ON OUR UNDERSTANDING OF UNIQUE COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS, AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. ST. FRANCIS CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013 IN CONJUNCTION WITH THE PUBLIC HEALTH DEPARTMENTS FROM BOTH WILKIN COUNTY, MN AND RICHLAND COUNTY, ND, AS WELL AS THE TWO CLINICS IN OUR COMMUNITY. THE THREE MAIN AREAS OF NEED IDENTIFIED FROM THE DATA COLLECTED WERE OBESITY MANAGEMENT, SUBSTANCE USE AND ABUSE, AND MENTAL HEALTH. II. QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT BENEFITS FOR BROADER COMMUNITY: COMMUNITY BUILDING ACTIVITIES # OF PERSONS - 6,000; COMMUNITY BENEFIT - $2,333 HEALTH PROFESSIONS EDUCATION # OF PERSONS - 84; COMMUNITY BENEFIT - $21,174 SUBSIDIZED HEALTH SERVICES # OF PERSONS - 100; COMMUNITY BENEFIT - $1,139,152 TOTAL BENEFITS FOR THE BROADER COMMUNITY: # OF PERSONS - 6,184; COMMUNITY BENEFIT - $1,162,659 AS SHOWN IN THE ABOVE TABLE, ST. FRANCIS HOME PROVIDED OVER $1,135,000 OF SUBSIDIZED CARE DURING FISCAL YEAR 2014. MUCH OF THIS WAS DUE TO NON-REIMBURSED COSTS FOR SERVICES PROVIDED TO MEDICAID PATIENTS AND OTHER INDIGENT CARE PROGRAMS. MEDICAID REPRESENTS APPROXIMATELY 57% OF THE RESIDENT POPULATION FOR ST. FRANCIS HOME. III. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT ST. FRANCIS HOME SERVED AS A CLINICAL SETTING FOR HEALTH PROFESSION STUDENTS DURING THROUGHOUT THE YEAR AT AN ESTIMATED VALUE OF $21,000.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. 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. ANY VACANCY OF AN APPOINTED EXECUTIVE COMMITTEE MEMBERSHIP MAY BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM IN THE MANNER THAT THE ORIGINAL COMMITTEE MEMBER WAS APPOINTED. 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. ADDITIONALLY, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS OR THE CORPORATE MEMBER, WITH THE BYLAWS, OR WITH APPLICABLE LAW. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE PROMPTLY REPORTED TO THE BOARD OF DIRECTORS AT THE NEXT REGULAR OR ANNUAL MEETING OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL MEET AT SUCH TIMES AS SHALL BE DETERMINED BY THE CHAIRPERSON. THE EXECUTIVE COMMITTEE SHALL KEEP REGULAR MINUTES OF ITS PROCEEDINGS AND REPORT THE SAME TO THE BOARD OF DIRECTORS AT EACH REGULAR MEETING OF THE BOARD.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
THE SOLE CORPORATE MEMBER OF ST. FRANCIS HOME IS CATHOLIC HEALTH INITIATIVES (CHI), A COLORADO NON-PROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
THE ORGANIZATION'S SOLE CORPORATE MEMBER HAS THE POWER TO REMOVE, REPLACE OR APPOINT THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY.
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 5.2 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 ST. FRANCIS HOME; * AMENDMENT OF THE CORPORATE DOCUMENTS OF ST. FRANCIS HOME; * APPROVE MEMBERS OF THE ST. FRANCIS HOME BOARD; * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. FRANCIS HOME; * APPROVAL OF ISSUANCE OF DEBT BY ST. FRANCIS HOME; * APPROVAL OF PARTICIPATION OF ST. FRANCIS HOME IN A JOINT VENTURE; * APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. FRANCIS HOME; * APPROVAL OF A MERGER INVOLVING ST. FRANCIS HOME; * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ST. FRANCIS HOME; * TO REQUIRE THE TRANSFER OF ASSETS BY THE ST. FRANCIS HOME TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS; * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR ST. FRANCIS HOME. 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
ST. FRANCIS HOME'S BOARD OF DIRECTORS HAS A FORM 990 REVIEW SUBCOMMITTEE THAT CONSISTS OF AT LEAST TWO COMMUNITY MEMBERS WITH TAX RETURN EXPERIENCE, ST. FRANCIS HOME'S CEO, CFO AND AN ACCOUNTANT. WHEN THE RETURN IS PREPARED, IT IS REVIEWED BY THE CHIEF FINANCIAL OFFICER, WHO PRESENTS IT TO THE FORM 990 SUBCOMMITTEE FOR ADDITIONAL REVIEW. AFTER ANY NECESSARY REVISIONS ARE MADE, THE RETURN IS AVAILABLE TO THE BOARD MEMBERS PRIOR TO FILING THE RETURN. SUBSEQUENTLY, CHI TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL 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
ST. FRANCIS HOME HAS A BOARD POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. AT THE ANNUAL BOARD MEETINGS ALL MEMBERS ARE REQUESTED TO SIGN CONFLICT OF INTEREST STATEMENTS. THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE FILES. ALL MEMBERS ARE REQUESTED TO DECLARE POTENTIAL CONFLICTS OF INTEREST AT EACH BOARD AND/OR COMMITTEE MEETING OF THE BOARD (FINANCE/AUDIT AND COMPLIANCE COMMITTEE AND THE PERFORMANCE IMPROVEMENT COMMITTEE). IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING. IN ADDITION, A QUESTIONNAIRE IS SENT ANNUALLY TO ALL BOARD MEMBERS AND TOP PAID EMPLOYEES ASKING THEM TO DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS.
FORM 990, PART VI, LINE 15A, PROCESS FOR DETERMINING COMPENSATION FOR 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, LINE 15B, PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS
DURING THE TAX YEAR ENDED 6/30/2014, NO OFFICERS, DIRECTORS OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THESE QUESTIONS ARE MORE APPROPRIATELY ANSWERED AS N/A.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
ST. FRANCIS HOME'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part IX, Line 11g, Other Expenses
SALARIES & BENEFITS PAID BY A RELATED ORGANIZATION - TOTAL EXPENSE: 4878653, PROGRAM SERVICE EXPENSE: 4791103, MANAGEMENT AND GENERAL EXPENSES: 87550, FUNDRAISING EXPENSES: ; LAUNDRY SERVICES - TOTAL EXPENSE: 88020, PROGRAM SERVICE EXPENSE: 88020, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONTRACT LABOR - HEALTHCARE - TOTAL EXPENSE: 172431, PROGRAM SERVICE EXPENSE: 140138, MANAGEMENT AND GENERAL EXPENSES: 32293, FUNDRAISING EXPENSES: ; HOUSEKEEPING SERVICES - TOTAL EXPENSE: 12618, PROGRAM SERVICE EXPENSE: 12618, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; OTHER PROFESSIONAL SERVICES - TOTAL EXPENSE: 560, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 560, FUNDRAISING EXPENSES: ;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.