Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
SAINT FRANCIS HOSPITAL INC |
730700090 | 3 | Yes | 1,124,892 | 0 | |
| Total 1 | 1,124,892 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III | STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS SAINT FRANCIS HOME HEALTH, INC., A RELATED PARTY OF SAINT FRANCIS HEALTH SYSTEM, OFFERS A WIDE RANGE OF PROFESSIONALS WHO CAN PROVIDE THE CARE NEEDED TO HELP PATIENTS MAINTAIN AS MUCH OF AN INDEPENDENT LIFESTYLE AS POSSIBLE, FOR THOSE PATIENTS TRANSITIONING FROM HOSPITAL TO HOME OR THOSE WHO HAVE SPECIAL HEALTHCARE NEEDS. SAINT FRANCIS HOME HEALTH, INC. ENCOMPASSES TWO SEPARATE BUT VITALLY CONNECTED SERVICES. THESE SERVICES INCLUDE: SAINT FRANCIS HOME HEALTH AND SAINT FRANCIS HOSPICE. SAINT FRANCIS HOME HEALTH AND HOSPICE ARE ACCREDITED BY THE JOINT COMMISSION, THE PREMIER HEALTHCARE ACCREDITATION ENTITY IN THE UNITED STATES. THE JOINT COMMISSION ACCREDITS MORE THAN 20,000 HEALTHCARE ORGANIZATIONS IN THE UNITED STATES AND MANY OTHER COUNTRIES. BY ASKING FOR ACCREDITATION, AN ORGANIZATION AGREES TO BE MEASURED AGAINST NATIONAL STANDARDS SET BY HEALTH CARE PROFESSIONALS. AN ACCREDITED ORGANIZATION SUBSTANTIALLY COMPLIES WITH JOINT COMMISSION STANDARDS AND CONTINUOUSLY MAKES EFFORTS TO IMPROVE THE CARE AND SERVICES IT PROVIDES. SAINT FRANCIS HOME HEALTH AND HOSPICE CONSISTENTLY RECEIVE SUPERIOR RATINGS FOR MAINTAINING STANDARDS OF EXCELLENCE REPRESENTING THEIR COMMITMENT TO QUALITY IN THE COMMUNITY. PART III, LINE 4A SAINT FRANCIS HOME HEALTH: SAINT FRANCIS HOME HEALTH OFFERS A WIDE RANGE OF PROFESSIONALS WHO CAN PROVIDE THE CARE NEEDED TO HELP INDIVIDUALS MAINTAIN AS MUCH OF AN INDEPENDENT LIFESTYLE AS POSSIBLE. THESE PROFESSIONALS INCLUDE: * SKILLED NURSES--THESE NURSES PROVIDE THE EXPERTISE TO HELP WITH MEDICAL ACTIVITIES SUCH AS DRESSING A WOUND, ADMINISTERING AN IV, AND PROVIDING PHYSICAL ASSESSMENTS. THE SKILLED NURSES WILL ALSO EDUCATE THE PATIENT AND HIS/HER LOVED ONES ON MATTERS SUCH AS SAFE ADMINISTRATION OF MEDICATION AND MAINTAINING A SAFE HOME ENVIRONMENT. * CERTIFIED HOME HEALTH AIDES--THESE AIDES PROVIDE PERSONAL CARE FOR A SHORT PERIOD OF TIME (USUALLY ABOUT TWO WEEKS) UNTIL THE PATIENT REGAINS THE STRENGTH NEEDED TO PROVIDE HIS/HER OWN CARE. * THERAPISTS--THE THERAPISTS SPECIALIZE IN A VARIETY OF AREAS, SUCH AS PHYSICAL THERAPY, WHICH EMPHASIZES STRENGTH AND MOBILITY; OCCUPATIONAL THERAPY, WHICH EMPHASIZES SAFETY IN THE HOME AND ADAPTING TO DISABILITIES WITHIN THE HOME ENVIRONMENT; AND SPEECH THERAPY, WHICH EMPHASIZES SPEECH PATTERNS, SWALLOWING, AND COGNITIVE ISSUES. * MEDICAL SOCIAL WORKER--THE SOCIAL WORKER WILL WORK WITH THE PATIENT TO IDENTIFY COMMUNITY RESOURCES AND SUPPORT SYSTEMS AND WILL DISCUSS ADVANCE DIRECTIVES (IF PATIENT DESIRES). SAINT FRANCIS HOME HEALTH (Home Health) ALSO MAKES HOME SAFETY EVALUATIONS. HOME HEALTH STAFF WILL EVALUATE THE HOME FOR BASIC SAFETY, INCLUDING THE PATIENT'S ABILITY TO SAFELY PERFORM ACTIVITIES OF DAILY LIVING. HOME HEALTH'S GOAL IS NOT TO BECOME A PERMANENT FIXTURE IN THE PATIENT'S HOME, BUT TO PROVIDE EXCELLENT CARE TO HELP THE PATIENT REGAIN HIS/HER HEALTH. HOME HEALTH IS A FRIEND TO THE PATIENT AND ACTS AS "THE EYES" OF THE DOCTOR. PART III, LINE 4B SAINT FRANCIS HOSPICE: THE SAINT FRANCIS HOSPICE PROGRAM IS A MEDICARE-CERTIFIED PROGRAM DESIGNED TO PROVIDE COMFORT AND SUPPORTIVE CARE FOR THE TERMINALLY ILL PATIENTS IN THE PRIVACY OF THEIR HOMES. IN SEPTEMBER 2007, SAINT FRANCIS HOSPICE BEGAN PROVIDING INPATIENT PALLIATIVE CARE. SAINT FRANCIS HOSPICE IS AVAILABLE TO LEND EMOTIONAL SUPPORT AND GUIDANCE TO THE FAMILY MEMBERS WHEN THEY NEED IT MOST. THE CONCEPT BEHIND HOSPICE IS TO AFFIRM LIFE. HOSPICE EXISTS TO SUPPORT AND CARE FOR THOSE FACING THE FINAL PHASE OF AN INCURABLE ILLNESS. ITS GOAL IS TO HELP THE PATIENT REMAIN PAIN-FREE AS Possible AND ENSURE THAT COMFORT IS PROMOTED, DIGNITY IS RESPECTED, AND QUALITY OF LIFE IS EMPHASIZED. SAINT FRANCIS HOSPICE'S CAREFULLY CRAFTED TEAM OF HEALTHCARE PROFESSIONALS PROVIDES CARE TO PATIENTS AND THEIR FAMILIES. THE MULTIDISCIPLINARY TEAM INCLUDES SPECIALLY TRAINED REGISTERED NURSES AND HOME HEALTH AIDES, AS WELL AS OTHER HEALTHCARE WORKERS WHO BRING DIFFERENT LEVELS OF EXPERTISE IN THE MANAGEMENT OF THE TERMINALLY ILL PATIENT. CARE CAN BE GIVEN IN THE PATIENT'S HOME OR TO THOSE RESIDING IN NURSING CARE FACILITIES. ALL CARE IS PROVIDED UNDER THE DIRECTION OF THE PATIENT'S PERSONAL PHYSICIAN AND THE MEDICAL DIRECTOR OF THE PROGRAM. SOME OF THE SERVICES PROVIDED BY SAINT FRANCIS HOSPICE INCLUDE: 24-HOUR ON-CALL STAFF AVAILABILITY; HOME VISITS BY registered nurses AND HOME HEALTH AIDES; MEDICAL EQUIPMENT AND SUPPLIES; PRESCRIPTION MEDICATIONS RELATED TO ILLNESS; NUTRITIONAL SUPPLEMENTS; SOCIAL SERVICE VISITS; INPATIENT PALLIATIVE CARE; VOLUNTEER SERVICES; SPIRITUAL AND GRIEF COUNSELING; RESPITE CARE; DIETARY COUNSELING; SPEECH, OCCUPATIONAL, AND PHYSICAL THERAPY; AND bereavement counseling for the family up to 13 months after the patient's death. months after the patient's death. |
| FORM 990, PART V, LINE 2B | FOLLOWING THE REVENUE PROCEDURE 70-6, 1970-C.B.420 SAINT FRANCIS PAYROLL SERVICES, LLC., EIN 45-0470422, HAS BEEN AUTHORIZED TO ACT AS THE COMMON PAY AGENT UNDER SECTION 3504 OF THE INTERNAL REVENUE CODE FOR SAINT FRANCIS HOME HEALTH, INC., EFFECTIVE JULY 1, 2002. AS OF THAT DATE, SAINT FRANCIS PAYROLL SERVICES, LLC. ASSUMED REPORTING OBLIGATIONS FOR FEDERAL INCOME TAX, SOCIAL SECURITY, MEDICARE, AND BACKUP WITHHOLDING TAX PURPOSES AS WELL AS ADVANCE PAYMENT OF EARNED INCOME CREDIT FOR SAINT FRANCIS HOME HEALTH, INC., INCLUDING YEAR END REPORTING. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE MEMBER, WHO ELECTS THE MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION HAS ONE MEMBER, WHO ELECTS THE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B The Board of Directors and a majority of the Members approve the sale of corporate assets valued at $10,000,000 or more. The Members have sole authority to: - Amend the Certificate of Incorporation - Approve mergers or consolidations - Approve the sale, lease or transfer of all, or substantially all, of the assets of the corporation - Amendment of bylaws - Appointment of Board members |
| FORM 990, PART VI, SECTION B, LINE 11B | The Finance Committee (a sub-committee of the Board of Directors of Saint Francis Health System, Inc. who is the parent of the sole member, Saint Francis Hospital, Inc.) has access to review the password protected Form 990 online prior to the filing with the IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION BY RESOLUTION HAS ADOPTED THE COMPLIANCE POLICIES OF SAINT FRANCIS HEALTH SYSTEM, INC., WHICH INCLUDES A CONFLICT OF INTEREST, WHISTLEBLOWER, AND RECORD RETENTION POLICY. THE GOVERNING BODY AND KEY EMPLOYEES CONFLICTS ARE DISCLOSED REGULARLY TO THE MEMBER ORGANIZATION WHICH ARE REVIEWED AND MANAGED BY THE GOVERNING BODY. NO CONFLICTS SPECIFIC TO THIS ORGANIZATION WERE REPORTED. |
| FORM 990, PART VI, SECTION B, LINES 15A & B | THE COMPENSATION OF OFFICIALS AND KEY EMPLOYEES IS annually REVIEWED AND APPROVED BY A COMMITTEE OF DIRECTORS WITH GUIDANCE FROM INDEPENDENT CONSULTANTS AND USE OF COMPARATIVE DATA. PART VII, SECTION A, LINE 1a THE HOURS PER WEEK FOR OFFICERS AND DIRECTORS ARE THE HOURS SPENT ON THE FILING ENTITY ONLY. THE REMAINING PORTION OF THE 40 HOURS PER WEEK OF THE OFFICERS AND DIRECTORS WITH RELATED COMPENSATION IS ALLOCATED AMONG THE ENTITIES REPORTED ON SCHEDULE R. |
| FORM 990, PART XI, LINE 9 | THE OTHER CHANGES IN NET ASSETS OR FUND BALANCES OF -$1,124,892 REPRESENTS DIVIDENDS PAID BY SAINT FRANCIS HOME HEALTH, INC. |
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| Software Version: |