Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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 | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 436,133 | 698,891 | 606,397 | 2,593,787 | 2,282,010 | 6,617,218 |
| 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 | 2,680,445 | 2,599,832 | 2,296,166 | 2,056,936 | 1,340,239 | 10,973,618 |
| 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 | 3,116,578 | 3,298,723 | 2,902,563 | 4,650,723 | 3,622,249 | 17,590,836 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 401,563 | 531,191 | 559,921 | 1,756,273 | 985,431 | 4,234,379 |
| 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 | |||||
| c | Add lines 7a and 7b.. | 401,563 | 531,191 | 559,921 | 1,756,273 | 985,431 | 4,234,379 |
| 8 | Public support. (Subtract line 7c from line 6.) | 13,356,457 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 3,116,578 | 3,298,723 | 2,902,563 | 4,650,723 | 3,622,249 | 17,590,836 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,477 | 2,310 | 3,788 | 4,615 | 349 | 12,539 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,477 | 2,310 | 3,788 | 4,615 | 349 | 12,539 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 9,172 | 9,172 | ||||
| 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.).. | 3,118,055 | 3,310,205 | 2,906,351 | 4,655,338 | 3,622,598 | 17,612,547 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1 AND PART III, LINE 1: | FRANCISCAN CARE SERVICES, AN ENTITY OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, WAS ESTABLISHED IN 2011 TO MEET THE RAPIDLY GROWING NEEDS OF HAWAII'S RAPIDLY GROWING OLDER ADULT POPULATION AND THE CORRESPONDING NEEDS OF FAMILY CAREGIVERS. FRANCISCAN CARE SERVICES CURRENTLY INCLUDES THE FRANCISCAN ADULT DAY CENTER IN MANOA, ALSO KNOWN AS THE SISTER MAUREEN INTERGENERATIONAL LEARNING ENVIRONMENT (SMILE), THE ST. FRANCIS INTERGENERATIONAL CENTER IN EWA VILLAGES, PROVIDE MANAGEMENT/CARE SERVICES FOR A PRIVATE CARE HOME IN MANOA FOR THE SISTER OF ST FRANCIS, OPERATES THE HAWAII BONE MARROW DONOR REGISTRY PROGRAM AND CAREGIVER SUPPORT PROGRAM WHICH OFFER CLASSES TO THE COMMUNITY. IN THE SPRING OF 2013, THE ST. FRANCIS INTERGENERATIONAL CENTER IN EWA VILLAGES, OPENED AND FEATURES A MONTESSORI-BASED PRESCHOOL AND ADULT DAY CARE UNDER ONE ROOF, AND IS MODELED AFTER THE SUCCESSFUL FRANCISCAN ADULT DAY CENTER IN MANOA. FRANCISCAN CARE SERVICES ALSO TOOK OVER OPERATION OF THE ADULT DAY CARE PROGRAM AT DIAMOND HEAD FROM SPECIAL EDUCATION CENTERS OF HAWAII (SECOH) FROM JULY 1, 2018 TO JUNE 30, 2022. |
| FORM 990, PART V, LINE 2A; PART VII, SECTION A; AND PART IX: | FRANCISCAN CARE SERVICES DOES NOT HAVE EMPLOYEES BUT SHARES THE COSTS OF PERSONNEL, SERVICES, FACILITIES AND EXPENSES WITH ITS PARENT, ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII. |
| FORM 990, PART VI, SECTION A, LINE 1A | ALL OF THE POWERS, AUTHORITY, RIGHTS, AND DUTIES ACCORDED TO THE BOARD OF DIRECTORS OF THE CORPORATION UNDER THE ARTICLES OF INCORPORATION, AS SO AMENDED, THE BYLAWS, AS SO AMENDED, AND THE HAWAII NONPROFIT CORPORATIONS ACT SHALL BE DELEGATED TO THE BOARD OF DIRECTORS OF ST. FRANCIS HEALTHCARE SYSTEM (SFHS) OF HAWAII SO THAT THE BOARD OF DIRECTORS OF SFHSH SHALL MANAGE EXCLUSIVELY THE CORPORATION'S BUSINESS AND AFFAIRS; AND FURTHER, THAT ANY OFFICER OF THE CORPORATION, ACTING ALONE OR TOGETHER WITH ANY OTHER OFFICER OF THE CORPORATION, IS AUTHORIZED, EMPOWERED AND DIRECTED, ON BEHALF OF THE CORPORATION AND IN ITS NAME, TO EXECUTE ANY APPLICATIONS, CERTIFICATES, AGREEMENTS OR ANY OTHER INSTRUMENTS OR DOCUMENTS OR AMENDMENTS OR SUPPLEMENTS THERETO, AND TO DO AND CAUSE TO BE DONE ANY AND ALL OTHER ACTS AND THINGS AS SUCH OFFICERS MAY IN THEIR DISCRETION DEEM NECESSARY, APPROPRIATE OR HELPFUL TO CARRY OUT THE PURPOSE AND EFFECT THE INTENT OF ANY OF THE FOREGOING RESOLUTIONS, THE EXECUTION AND DELIVERY THEREOF BY EACH SUCH OFFICER OR THE TAKING OF EACH SUCH ACT TO BE CONCLUSIVE EVIDENCE OF THE NECESSITY OR APPROPRIATENESS THEREOF. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE CORPORATE MEMBER OF FRANCISCAN CARE SERVICES IS ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII. |
| FORM 990, PART VI, SECTION A, LINE 7A | ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, AS THE SOLE CORPORATE MEMBER, APPROVES THE APPOINTMENT OF THE BOARD OF DIRECTORS OF FRANCISCAN CARE SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 7B | ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII, AS THE SOLE CORPORATE MEMBER, HAS THE FOLLOWING POWERS RESERVED TO APPROVE THE FOLLOWING: THE GENERAL POWERS GRANTED TO THE BOARD OF DIRECTORS ARE LIMITED OR RESTRICTED TO THE EXTENT THAT CERTAIN ACTIONS OF THE CORPORATION REQUIRE THE APPROVAL AND CONSENT OF THE SOLE MEMBER AS FOLLOWS: (A) APPROVAL OF THE CORPORATION'S ANNUAL BUDGET, INCLUDING BUDGETS FOR OPERATIONS, CAPITAL EXPENDITURES, AND CASH FLOW; (B) APPROVAL OF THE APPOINTMENT OF THE CHIEF OPERATING OFFICER OF THE CORPORATION; (C) ANY CHANGE IN PURPOSE, PHILOSOPHY OR OBJECTIVES OF THE CORPORATION; (D) FINAL DECISION ON THE NUMBER OF DIRECTORS CONSTITUTING THE ENTIRE BOARD OF DIRECTORS AND THE APPOINTMENT OR REMOVAL OF ANY MEMBER(S) AND ELECTED OFFICER(S) OF THE BOARD OF DIRECTORS; (E) ANY LOANS OR EVIDENCES OF INDEBTEDNESS WHICH ARE SECURED BY OR AFFECT THE REAL PROPERTY AND/OR ASSETS OF THE CORPORATION OR OF THE SOLE MEMBER OR THE SOLE MEMBER'S SUBSIDIARY CORPORATIONS AND CONTRACTED ON BEHALF OF THE CORPORATION; AND (F) AMENDMENT OF THE ARTICLES OF INCORPORATION AND/OR THESE BYLAWS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 AND SUPPORTING WORKPAPERS WERE REVIEWED BY THE CHIEF FINANCIAL OFFICER OF ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII AND THE COMPANY'S TAX ADVISORS, KMH LLP. A COPY OF FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED PRIOR TO EMPLOYMENT FOR ALL EMPLOYEES AND DIRECTORS. CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY HR PERSONNEL AND UPDATED ON AN ANNUAL BASIS. AFTER REVIEW BY HR PERSONNEL, POTENTIAL CONCERNS ARE REFERRED TO MANAGEMENT PERSONNEL AND RECOMMENDATIONS FOR RESOLUTIONS OF CONFLICTS ARE REFERRED TO THE CORPORATE COMPLIANCE STEERING COMMITTEE. IF A POTENTIAL OR IDENTIFIED CONFLICT OF INTEREST CANNOT BE RESOLVED BY THE AFOREMENTIONED COMMITTEE, THE MATTER WILL BE REFERRED TO THE ORGANIZATIONAL ETHICS COMMITTEE FOR ADVICE AND RECOMMENDATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE GENERAL PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | ROUNDING 1. CURRENT YEAR DONATIONS RESTRICTED FOR ST. FRANCIS INTERGENERATIONAL CENTER 111,127. NET ASSETS RELEASED FROM RESTRICTION -410,093. |
| Software ID: | |
| Software Version: |