Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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)
DIGNITY HEALTH DBA ST JOSEPH'S HOSPITAL & MEDICAL CENTER |
941196203 | 3 | Yes | 184,104 | 0 | |
|
Total 1
|
184,104 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 | 0 | 0 | ||
| 2 | Recoveries of prior-year distributions | 2 | 0 | 0 | ||
| 3 | Other gross income (see instructions) | 3 | 55,138 | 65,988 | ||
| 4 | Add lines 1 through 3 | 4 | 55,138 | 65,988 | ||
| 5 | Depreciation and depletion | 5 | 0 | 0 | ||
| 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 | 0 | 0 | ||
| 7 | Other expenses (see instructions) | 7 | 12,247 | 25,914 | ||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | 42,891 | 40,074 | ||
| 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 | 3,735,298 | 3,757,728 | ||
| b | Average monthly cash balances | 1b | 60,967 | 74,976 | ||
| c | Fair market value of other non-exempt-use assets | 1c | 0 | 0 | ||
| d | Total (add lines 1a, 1b, and 1c) | 1d | 3,796,265 | 3,832,704 | ||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): 0 |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | 0 | 0 | ||
| 3 | Subtract line 2 from line 1d | 3 | 3,796,265 | 3,832,704 | ||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | 56,944 | 57,491 | ||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | 3,739,321 | 3,775,213 | ||
| 6 | Multiply line 5 by .035 | 6 | 130,876 | 132,132 | ||
| 7 | Recoveries of prior-year distributions | 7 | 0 | 0 | ||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | 130,876 | 132,132 | ||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | 42,891 | |||
| 2 | Enter 85% of line 1 | 2 | 36,457 | |||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | 130,876 | |||
| 4 | Enter greater of line 2 or line 3 | 4 | 130,876 | |||
| 5 | Income tax imposed in prior year | 5 | 0 | |||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | 130,876 | |||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 144,244 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
39,860 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 61,757 | |
| 4 Amounts paid to acquire exempt-use assets | 0 | |
| 5 Qualified set-aside amounts (prior IRS approval required) | 0 | |
| 6 Other distributions (describe in Part VI). See instructions | 0 | |
| 7Total annual distributions. Add lines 1 through 6. | 245,861 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
144,244 | |
| 9 Distributable amount for 2018 from Section C, line 6 | 130,876 | |
| 10 Line 8 amount divided by Line 9 amount | 10000.0000000000 % | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
130,876 | |||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
0 | |||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013.......0 | ||||
| b From 2014.......0 | ||||
| c From 2015.......0 | ||||
| d From 2016.......0 | ||||
| e From 2017.......116,460 | ||||
| fTotal of lines 3a through e | 116,460 | |||
| g Applied to underdistributions of prior years | 0 | |||
| h Applied to 2018 distributable amount | 116,460 | |||
|
i
Carryover from 2013 not applied (see instructions) |
0 | |||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | 0 | |||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ 245,861 | ||||
| a Applied to underdistributions of prior years | 0 | |||
| b Applied to 2018 distributable amount | 14,416 | |||
| c Remainder. Subtract lines 4a and 4b from 4. | 231,445 | |||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
0 | |||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
0 | |||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
231,445 | |||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014......0 | ||||
| b Excess from 2015.....0 | ||||
| c Excess from 2016.....0 | ||||
| d Excess from 2017.....0 | ||||
| e Excess from 2018.....231,445 | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, SECTION A, LINE 6 | ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER'S BARROW NEUROLOGICAL CENTER IS WORKING WITH JOINT NEUROSCIENCES COUNCIL'S EBRAIN PROGRAM, ONE OF THE LARGEST NEUROSCIENCE E-LEARNING PROGRAMS IN THE WORLD. EBRAIN CONTENT COVERS THE WHOLE OF CLINICAL NEUROSCIENCE. THE EFFORT WILL PRODUCE RESULTS THAT WILL DIRECTLY BENEFIT ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER. |
| SCHEDULE A, PART IV SECTION D, LINE 3 | THE SUPPORTED ORGANIZATION APPOINTS THE CHAIR OF THE FOUNDATION. THE FOUNDATION'S CHAIR, CEO, AND CFO ARE ALL OFFICERS OF THE SUPPORTED ORGANIZATION OR OF ONE OF THE SUPPORTED ORGANIZATIONS THAT ALSO SUPPORT THE BARROW NEUROLOGICAL INSTITUTE. ADDITIONALLY, ONE OF THE FOUNDATION'S TRUSTEES MUST ALSO BE THE MEDICAL DIRECTOR OF BARROW NEUROLOGICAL INSTITUTE, A DIVISION OF THE SUPPORTED ORGANIZATION. |
| SCHEDULE A, PART V, SECTION D, LINE 8 | THE FOUNDATION SUPPORTS THE PROVISION OF CLINICAL SERVICES AT BARROW NEUROLOGICAL INSTITUTE, A DIVISION OF DIGNITY HEALTH, DBA ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER. THE FOUNDATION HAS A LONG AND HISTORICAL RELATIONSHIP WITH DIGNITY HEALTH SINCE THE FOUNDATION WAS FORMED IN 1998. THE FOUNDATION'S OFFICERS ARE ALSO EMPLOYEES OF DIGNITY HEALTH OR ONE OF DIGNITY HEALTH'S OTHER SUPPORTING ORGANIZATIONS: - THE FOUNDATION'S BOARD CHAIR IS THE DIGNITY HEALTH SENIOR VICE PRESIDENT OF OPERATIONS IN ARIZONA - THE FOUNDATION'S CEO IS THE CEO OF ST. JOSEPH'S FOUNDATION, A TYPE I SUPPORTING ORGANIZATION OF DIGNITY HEALTH DBA ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER. - THE FOUNDATION'S CFO IS THE CFO OF DIGNITY HEALTH DBA ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER. - THE BARROW NEUROLOGICAL INTITUUTE'S MEDICAL DIRECTOR IS A FOUNDATION TRUSTEE. |
| Software ID: | |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART V, LINE 2A | THE ORGANIZATION DOES NOT HAVE EMPLOYEES. AS A SUPPORTING ORGANIZATION, THE FOUNDATION OPERATES FOR THE BENEFIT OF THE HOSPITAL AND UTILIZES THE EMPLOYEES OF THAT HOSPITAL. THE SALARIES OF THESE EMPLOYEES ARE INCLUDED IN THE HOSPITAL ENTITY'S FORM W-3 AND FEDERAL EMPLOYMENT TAX RETURNS. |
| FORM 990, PART VI, SECTION A, LINE 3 | BARROW UK HAS NO EMPLOYEES. THE CEO DUTIES AND ADMINISTRATIVE FUNCTIONS ARE OUTSOURCED TO DIGNITY HEALTH. THE COST OF WHICH IS NOT REIMBURSED BY BARROW UK. THE CEO CONTRACTS WITH DIGNITY HEALTH TO PROVIDE THE CEO SERVICES THROUGH HER WHOLLY OWNED CONCERN, PUG VERT, AN UK ENTITY. SUBSTANTIALLY ALL CEO SERVICES ARE PERFORMED IN THE UK. IN THE CURRENT YEAR, PUG VERT WAS PAID A MANAGEMENT FEE OF $87,589. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS ARE THE TRUSTEES AND THE FOUNDER MEMBER OF THE ORGANIZATION, DIGNITY HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S FOUNDER MEMBER, DIGNITY HEALTH, MAY APPOINT AT LEAST TWO TRUSTEES. THE SUPPORTED ORGANZATION, ST. JOSEPH'S HOSPTIAL AND MEDICAL CENTER, IS A DIVISION OF DIGNITY HEALTH. THE PHYSICIAN SERVING AS THE MEDICAL DIRECTOR OF BARROW NEUROLOGICAL INSTITUTE, A DIVISION OF DIGNITY HEALTH, ALSO SERVES AS AN EX-OFFICIO TRUSTEE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION'S FOUNDER MEMBER, DIGNITY HEALTH, MUST APPROVE DISSOLUTION. IT MAY ALSO, AT IT SOLE DISCRETION, APPOINT A SUCCESSOR FOUNDER MEMBER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FOUNDATION'S RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. DUE TO THE TIMING, IT WAS REVIEWED BY THE CHAIR OF THE BOARD PRIOR TO FILING. AFTER FILING, COPIES OF THE RETURN WILL BE PROVIDED TO THE VICE PRESIDENT OF OPERATIONS AND CEO AS WELL AS THE FOUNDATION'S AUDIT AND FINANCE COMMITTEE AND THE FULL BOARD PRIOR TO THE BOARD'S FIRST MEETING SUBSEQUENT TO THE FILING DATE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE FOUNDATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. THE FOUNDATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THE CONFLICTS OF INTEREST POLICY, AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND BUSINESS RELATIONSHIPS AND TRANSACTIONS OR OTHER TRANSACTIONS THAT MAY POSE A POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (E.G., BOARD MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP, KEY EMPLOYEES). COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS AT THE TIME SUCH CONFLICTS ARISE. WHEN AN INDIVIDUAL BECOMES A COVERED PERSON AND ANNUALLY THEREAFTER, EACH COVERED PERSON IS REQUIRED TO SUBMIT AN UPDATED DISCLOSURE STATEMENT AND TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; (2) HAS READ THE POLICY AND UNDERSTAND SAID POLICY; AND (3) AGREES TO COMPLY WTIH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE STATEMENT. THE COMPLETED QUESTIONNAIRS ARE REVIEWED BY DIGNITY HEALTH'S LEGAL DEPARTMENT AND ANY PERSONS WITH ACTUAL OR PTENTIAL CONFLICTS ARE INFORMED VIA WRITTEN COMMUNICATION. THE PROCEDURES FOR ADDRESSING ANY CONFLICT OF INTEREST INCLUDE, BUT ARE NOT LIMTED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD; (2) THE INTEREST PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPPROVAL OF SUCH TRANSATCION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOESED TRANSACTION ARE INVESTIGATED, COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) ANY CONFLICTING ISSUES DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED IS REFERRED TO THE GOVERNANCE COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE APPROVED BY A MAJORITY OF DISINTERESTED PERSONS. ALL CONFLICTS OF INTEREST, WHETHER RESOLVED OR UNRESOLVED, ARE REPORTED IN THE FOUNDATION'S FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION DOES NOT EMPLOY PERSONNEL; HOWEVER, THE TOP MANAGEMENT OFFICIAL IS COMPENSATED BY DIGNITY HEALTH. FOR 2017 COMPENSATION, DIGNITY HEALTH'S HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOPHY AND PRINCIPLES, THE ANNUAL PERFORAMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPESNATION CRITERIA FOR OFFICERS AND KEY EMPLOYEES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERSATIONS INCLUDES (A) THE TERMS OF THE TRANSACTION APPROVED AND THE DATE APPROVED, (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED TRANSACTION AND THOSE WHO VOTED ON IT, AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. |
| FORM 990, PART VI, SECTION C, LINE 19 | FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
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