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
Via Christi Health Partners Inc
Employer identification number
48-0958974
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.") .
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......
7,844,009
7,698,211
8,638,772
8,876,394
8,836,514
41,893,900
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.
7,844,009
7,698,211
8,638,772
8,876,394
8,836,514
41,893,900
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
99,582
55,078
41,590
32,178
239,418
467,846
c
Add lines 7a and 7b..
99,582
55,078
41,590
32,178
239,418
467,846
8
Public support (Subtract line 7c from line 6.)
41,426,054
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...
7,844,009
7,698,211
8,638,772
8,876,394
8,836,514
41,893,900
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
972,817
1,138,516
1,178,952
1,016,782
2,437,699
6,744,766
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
586,070
599,514
652,503
692,808
1,080,292
3,611,187
c
Add lines 10a and 10b.
1,558,887
1,738,030
1,831,455
1,709,590
3,517,991
10,355,953
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.)..
9,402,896
9,436,241
10,470,227
10,585,984
12,354,505
52,249,853
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
79.280 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
79.310 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
19.820 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
17.110 %
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
Via Christi Health Partners Inc
Employer identification number
48-0958974
Return Reference
Explanation
Form 990, Part III:
Community Benefit Report: As a part of Via Christi Health, a Catholic health system, we share this mission: "Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." Via Christi Health's history extends back over 100 years and today, along with our sponsoring organization, Ascension Health, we continue to respond to community needs in Kansas and Northeastern Oklahoma. The obligation to reach out to those in need and improve community health flows directly from our identity as a faith-based healing ministry. As a mission-driven organization, we provide community benefit because we are committed to our core values of: - Service of the Poor Generosity of spirit, especially for persons most in need - Reverence Respect and compassion for the dignity and diversity of life - Integrity Inspiring trust through personal leadership - Wisdom - Integrating excellence and stewardship - Creativity Courageous innovation - Dedication Affirming the hope and joy of our ministry Via Christi Health Partners is the corporate office for joint ventures in ambulatory surgery (Center for Same Day Surgery and Kansas Surgery and Recovery); imaging services (AMS Diagnostics, MR Imaging, St. Joseph MRI, and Preferred Pet Imaging); durable medical equipment (Via Christi Home Medical Wichita, Salina Regional Home Medical Services and Mercy Regional Home Medical Services) and a medical office property management company (Via Christi Property Services). Via Christi Health Partners serves people in the Wichita Metropolitan Area and the communities of Salina, Manhattan, Dodge City, and Garden City, Kansas. The following Via Christi Health Partners companies serve as clinical education settings for college students: - AMS Diagnostics Radiology & Ultrasound Technician Students - MR Imaging Radiology Technician Students - St Joseph MRI Radiology Technician Students - Kansas Surgery & Recovery Center Nursing Students - Home Medical Services Respiratory Therapy & Pharmacy Students - Center for Same Day Surgery Medical Coding Students In addition, Via Christi Health Partners companies employees assist with: - Fundraising for other area not-for-profits through the annual One Community Campaign (in partnership with United Way) - Protecting the environment through a recycling program - Saving lives through sponsoring blood drives in partnership with the American Red Cross - Cash donations to a Communities in School (in partnership with Jefferson Elementary School), Arthritis Foundation, American Heart Association, Prairie Fire Half Marathon, Race for the Cure, among others - In-kind donations of time for The Lord's Diner, Cystic Fibrosis Walk, Catholic Charities Healthy Food Drive, American Heart Association Walk, and more The financial information in this report was prepared in accordance with the Catholic Health Association's Community Benefit reporting guidelines. These guidelines recommend the following: - Report Charity Care at cost, not charges - Do not include bad debt, contractual allowances and quick pay discounts as part of the Charity Care expense - Do not count Medicare shortfall as a community benefit - Report the net expense for community benefit services (e.g. the total community benefit expense minus any associated revenue from patients, payers and other external sources) For Fiscal Year Ended June 30, 2014 Community Benefit (VCHP Corporate Office Only) - $35,888 Community Benefit VCHP Consolidated: 1) Charity Care (At Cost) - $525,304 2) Government Sponsored Health Care Net Expense - ($135,528) (Unpaid cost of Public Indigent Care Programs includes Medicaid, SCHIP, other safety net programs, does not include Medicare shortfall) 3) Community Benefit Programs Net Expense - $167,579 Financial and In-Kind Donations - $145,825 Health Professions Education - $14,195 Community Benefit Operations - $3,195 Community Building Activities - $1,618 Community Health Improvement Services - $2,746 Total Quantifiable Community Benefit Expenses - $557,355
Form 990, Part VI, Section A, line 2
Many of the persons listed on Part VII have a "business relationship" with each other by virtue of employment by Via Christi Health, Inc. related entities.
Form 990, Part VI, Section A, line 6
Via Christi Health Partners, Inc. has a single corporate member, Via Christi Health, Inc.
Form 990, Part VI, Section A, line 7a
Via Christi Health Partners, Inc. has a single corporate member, Via Christi Health, Inc., who has the ability to elect members to the governing body of Via Christi Health Partners, Inc.
Form 990, Part VI, Section A, line 7b
All decisions that have a material impact to Via Christi Health Partners, Inc. financial information or corporation as a whole are subject to approval by its sole corporate member, Via Christi Health, Inc.
Form 990, Part VI, Section B, line 11
Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members' questions.
Form 990, Part VI, Section B, line 12c
The organization's Conflict of Interest Policy is monitored as part of the system-wide procedures of Via Christi Health, Inc. and not at the organizational level. The system-wide procedures are as follows: 1 - At time of appointment and annually thereafter, all interested persons, including board and committee members, complete a disclosure statement which addresses actual or potential conflicts of interest; 2 - The disclosure statement is done electronically and the return of the completed statement is a condition of continued appointment, employment, or participation with the organization; 3 - All actual or potential conflicts are reviewed, investigated, and resolved by the chief governance officer and the corporate responsibility officer, with the results shared with the chief executive of the organization; 4 - Periodic reviews are conducted by governance, compliance, and internal audit to ensure the organization is operating consistent with the policy and enforcing the policy's terms.
Form 990, Part VI, Section B, line 15
Via Christi Health Partners, Inc. follows the same compensation policy as Via Christi Health, Inc. (VCH) regarding compensation review. VCH has established a common philosophy, strategy, and processes for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: - Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope; - Difficulties in recruiting and retaining executives; - Skills, experience and performance history of individual executives; - Critical business or strategic issues that the organization may face; and - Market position for total compensation. The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the intermediate sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation.
Form 990, Part VI, Section C, line 19
Via Christi Health Partners, Inc.'s governing documents and Conflict of Interest Policy are available to the public upon request.
Form 990, Part VII:
Sister Sherri Marie Kuhn receives compensation from Via Christi Hospitals Wichita, Inc. Her compensation is not paid directly to her but is paid to religious order in accordance with her vow of poverty.
Form 990, Part XI, line 9:
Pension Adjustments 262,253.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.