2012-11-14T07:35:24-06:00 2011-12-31 990 2011-01-01 421106819 ST LUKE'S HEALTH CARE FOUNDATION STLU 3193697716 855 A AVENUE NE STE 105 CEDAR RAPIDS IA 52402 MILTON E AUNAN II 3193697796 2012-11-12 2011 2016-02-24 21:20:13Z THEODORE E TOWNSEND JR 855 A AVENUE NE STE 105 CEDAR RAPIDS IA 52402 16200663 0 X WWW.STLUKESFOUNDATION.COM X 1977 IA TO SUPPORT ST. LUKE'S HOSPITAL AS THE PREMIER RESOURCE FOR IMPROVING THE HEALTH OF EASTERN IOWANS. 22 21 0 21 12076 9465 2682528 1988168 324912 11885 857311 1129773 10677 291668 3875428 3421494 2225673 1105245 0 0 825529 985146 65211 100242 816679 654222 685659 3770635 2876292 104793 545202 33632587 32030568 3474588 3014002 30157999 29016566 X TO SUPPORT ST. LUKE'S HOSPITAL AS THE PREMIER RESOURCE FOR IMPROVING THE HEALTH OF EASTERN IOWANS. 0 0 1105245 1105245 303553 GRANTS, ALLOCATIONS AND PROGRAM SUPPORTST. LUKE'S HEALTH CARE FOUNDATION PURPOSE IS TO RAISE FUNDS TO MAINTAIN, DEVELOP, INCREASE AND EXTEND THE FACILITIES AND SERVICES OF ST. LUKE'S METHODIST HOSPITAL IN CEDAR RAPIDS, IOWA, AND TO PROVIDE BROADER HOSPITAL, MEDICAL AND EDUCATIONAL SERVICE OPPORTUNITIES TO ITS PATIENTS, STUDENTS, STAFF, FACULTY AND RESIDENTS OF THE GEOGRAPHICAL AREA IT SERVES. IT SUPPORTS THE MISSIONS OF ST. LUKE'S HEALTHCARE AND ITS SUBSIDIARIES BY RAISING FINANCIAL CONTRIBUTIONS AND INVESTING THE PROCEEDS.THE GRANTS, ALLOCATIONS AND PROGRAM SUPPORT SERVICES MAY INCLUDE:CONTRIBUTIONS TO ST. LUKE'S METHODIST HOSPITAL FOR EQUIPMENT PURCHASES, TO OFFSET OPERATING EXPENSES AND MISCELLANEOUSSCHOLARSHIPS AND/OR LECTURESHIPS AWARDED TO INDIVIDUALS ASSOCIATED WITH ST. LUKE'S METHODIST HOSPITALGRANTS TO LOCAL RURAL HEALTH COMMUNITIES ASSOCIATED WITH ST. LUKE'S METHODIST HOSPITALMISCELLANEOUS GRANTS AND CONTRIBUTIONS TO ORGANIZATIONS AND/OR INDIVIDUALS ASSOCIATED WITH ST. LUKE'S METHODIST HOSPITAL 1105245 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 10 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 22 21 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X MILTON E AUNAN II VP FINANCECFO 3193697796 1026 A AVENUE NE CEDAR RAPIDS IA 52402 X STEVE ALLSOP 1.00 X X 0 0 0 KENNETH ANDERSON MD 1.00 X 0 0 0 MILTON AUNAN II 1.00 X X 0 0 0 RYAN BURESH 1.00 X 0 0 0 TERRI CHRISTOFFERSEN 1.00 X X 0 0 0 SONDY DAGGETT 1.00 X 0 0 0 TIFFANY EARL 1.00 X 0 0 0 SALLY GRAY 1.00 X 0 0 0 PHIL HERSHNER 1.00 X 0 0 0 BILL HOCHSTETLER 1.00 X 0 0 0 SHIRLEY HOLTEY 1.00 X 0 0 0 JAMES LAMORGESE MD 1.00 X 0 0 0 DINA LINGE 1.00 X 0 0 0 MARK MATHIS 1.00 X 0 0 0 RITU MUNJAL MD 1.00 X 0 0 0 DOUG NEIGHBOR 1.00 X X 0 0 0 LON OLEJNICZAK 1.00 X 0 0 0 PAUL RHINES 1.00 X 0 0 0 PAULA ROBY 1.00 X 0 0 0 JAMES SEALY -- BOARD MEMBER 40.00 X X 33487 0 774 LYNN SUNDALL 1.00 X 0 0 0 NANCY SKOGSBERGH 1.00 X 0 0 0 THEODORE TOWNSEND JR 1.00 X 0 0 0 KIM WILKERSON 1.00 X 0 0 0 SUSAN RIGO 40.00 X 194880 0 82245 228367 0 83019 1 0 1 1 0 388004 1600164 89344 1988168 FOUNDATION SERVICE CTR 561000 172459 172459 SUBS & JOINT VENTURES 900099 -160574 -160574 11885 476541 12076 464465 13432401 12779169 653232 653232 653232 MISCELLANEOUS REVENUE 900099 291668 291668 291668 3421494 303553 12076 1117697 1083745 1083745 21500 21500 311386 311386 540849 234615 306234 132911 57655 75256 120 120 26725 13577 13148 100242 100242 91152 91152 64641 64641 58731 23370 35361 25616 12713 12903 61741 31366 30375 121572 61763 59809 6848 3479 3369 4593 553 4040 144770 73549 71221 41636 21153 20483 6429 3266 3163 MISCELLANEOUS EXPENSES 25274 11699 13575 INCOME TAXES 6112 3105 3007 BAD DEBT EXPENSE -301 -153 -148 2876292 1105245 954368 816679 130702 50000 1894514 1767822 477950 798873 298238 73193 205120 185779 24171 27464 2335273 277727 2086682 2057546 22701663 21873532 982450 674394 4831097 4521965 33632587 32030568 378232 372689 2228250 1931250 868106 710063 3474588 3014002 X 612956 -489042 11549929 11663367 17995114 17842241 30157999 29016566 33632587 32030568 X 545202 -1686635 X 0 1 1 X 0 X 5213626 5621554 4946261 2682528 1988168 20452137 5213626 5621554 4946261 2682528 1988168 20452137 6791214 13660923 2279781 1473958 679538 1019901 476541 5929719 13920 10667 13292 10675 48554 26430410 1019329 0.51690 0.48480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20118362 110410 -119031 530925 19578816 16840545 105118 3931219 758520 20118362 13887342 1410310 2356452 813559 16840545 13620710 266632 13887342 0.03430 0.71620 0.24950 0 0 2001224 2001224 209240 176148 33092 124809 101579 23230 2057546 INVESTMENT IN SUBSIDIARIES (ST. LUKE'S DEVELOPMENT CO.) 544486 C BENEFICIAL INTEREST IN UNITRUSTS 157719 F BENEFICIAL INTEREST IN PERPETUAL TRUSTS 3819760 F 4521965 LIABILITIES UNDER SPLIT INTEREST AGREEMENT 264463 LIABILITIES UNDER ANNUITIES 445600 710063 3421494 2876292 545202 -1616556 -70079 -1686635 -1141433 3131363 -1616556 1660115 43559 3087804 91152 242538 333690 3421494 4272796 1717234 1717234 2555562 91152 229578 320730 2876292 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION RETAINS FUNDS FOR INTENDED FUTURE USES, INCLUDING PURCHASE OF EQUIPMENT, INDIGENT CARE, FUNDING OF MISSION RELATED OPERATIONS, AND HEALTH EDUCATION. IN ADDITION, SOME FUNDS ARE HELD FOR INVESTMENT IN PERPETUITY. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TRUSTS -70,079. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATING ENTRIES 103,455. SUBSIDIARY ELIMINATING ENTRIES (ST. LUKE'S DEVELOPMENT CO.) 1,556,660. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TRUSTS 70,079. EXPENSE REIMBURSEMENTS/REVENUE OFFSETS (FOUNDATION SERVICE CENTER) 172,459. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SUBSIDIARY ELIMINATING ENTRIES (ST. LUKE'S DEVELOPMENT CO.) 1,717,234. PART XIII, LINE 4B - OTHER ADJUSTMENTS: ELIMINATING ENTRIES 57,119. EXPENSE REIMBURSEMENTS/REVENUE OFFSETS (FOUNDATION SERVICE CENTER) 172,459. X X X X X 1 RUFFALO-CODY PO BOX 3018 ATTN CONTROLLER CEDAR RAPIDS IA 52406 TELEFUNDRAISING 0 5575 35122 0 THOMPSON & ASSOCIATES 112 WESTWOOD PLACE SUITE 250 BRENTWOOD TN 37027 CONSULTING/PLANNED GIVING 0 0 65120 0 5575 100242 IA EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) THOMPSON & ASSOCIATES - PROVIDES CONSULTING TO FOUNDATION; CONDUCTS SEMINARS/PRESENTATIONS ON PLANNED GIVING. EXPENSES ARE RELATED TO RETAINER AND RELATED EXPENSES. RUFFALO CODY PROVIDES TELE-FUNDRAISING SERVICES FOR THE GRATEFUL PATIENT PROGRAM THROUGH PHONE CALLS TO PATIENTS DISCHARGED FROM ST LUKES HOSPITAL. 1 COE COLLEGE 1220 1ST AVE NE CEDAR RAPIDS IA 52402 420686467 501(C)(3) 6256 PROGRAM SUPPORT ST LUKE'S METHODIST HOSPITAL 1026 A AVENUE CEDAR RAPIDS IA 524063026 420504780 501(C)(3) 981564 PROGRAM SUPPORT 2 0 SCHOLARSHIPS 23 21500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS TO GOVERNMENTS AND ORGANIZATIONS: IRC SECTION 501(C)(3) ORGANIZATIONS RECEIVING GRANTS MUST PROVIDE EVIDENCE OF THEIR TAX EXEMPT STATUS. EACH ORGANIZATION RECEIVING FUNDING MUST SUBMIT A WRITTEN UPDATE, INCLUDING APPLICABLE EVIDENCE TO SUPPORT THE FUNDS WERE USED FOR THE INTENDED PURPOSE. SCHOLARSHIPS: BEFORE THE STUDENT CAN RECEIVE SCHOLARSHIP FUNDS, THEY MUST PROVIDE EVIDENCE OF ENROLLMENT FROM THE SCHOOL THEY ARE ATTENDING. AT THE CONCLUSION OF THEIR SEMESTER, THEY ARE REQUIRED TO SUBMIT A TRANSCRIPT OF RESULTS. CHECKS FOR SCHOLARSHIPS ARE JOINTLY ISSUED TO THE HIGHER EDUCATION INSTITUTION AND STUDENT. RURAL INITATIVE GRANTS: GRANTS ARE LIMITED TO COMMUNITIES IN THE ST. LUKE'S HOSPITAL MARKET AREA. GRANTEES ARE REQUIRED TO SUBMIT AN ANNUAL REPORT STATING HOW THE FUNDS HAVE BEEN UTILIZED. THE GRANTS ARE TYPICALLY IN SUPPORT OF EQUIPMENT PURCHASES. 0 0 0 0 0 0 0 0 0 SUSAN RIGO 135413 0 0 0 59467 0 75818 0 6427 0 277125 0 0 0 SUPPLEMENTAL INFORMATION PART III ST. LUKE'S METHODIST HOSPITAL PAYS COMPENSATION TO SUSAN RIGO, IN THE AMOUNTS OF: BASE PAY $135,413, BONUS & INCENTIVE COMPENSATION $0, OTHER COMPENSATION $59,467, DEFERRED COMPENSATION $75,818, NONTAXABLE BENEFITS $6,427. ST. LUKE'S HEALTH CARE FOUNDATION REIMBURSES ST. LUKE'S METHODIST HOSPITAL FOR PART OF THE COMPENSATION PAID TO SUSAN RIGO. ST. LUKE'S METHODIST HOSPITAL PAYS COMPENSATION TO JAMES SEALY, IN THE AMOUNTS OF: BASE PAY $32,308, BONUS & INCENTIVE COMPENSATION $0, OTHER COMPENSATION $1,179, DEFERRED COMPENSATION $738, NONTAXABLE BENEFITS $36. ST. LUKE'S HEALTH CARE FOUNDATION REIMBURSES ST. LUKE'S METHODIST HOSPITAL FOR PART OF THE COMPENSATION PAID TO JAMES SEALY. X 1 89344 FAIR MARKET VALUE 0 0 1 1 THIRD PARTY USE: PART I, LINE 32B: BROKER SERVICE UTILIZED TO SELL STOCK DONATIONS. FORM 990, PART VI, SECTION A, LINE 7A ST. LUKE'S METHODIST HOSPITAL APPOINTS AT LEAST ONE BOARD MEMBER, THE ST. LUKES METHODIST HOSPITAL CEO AND CFO ARE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE IOWA HEALTH SYSTEM TAX DEPARTMENT USING INFORMATION GATHERED FROM VARIOUS FUNCTIONAL AREAS OF THE ORGANIZATION. EACH SECTION OF THE RETURN IS REVIEWED BY FUNCTIONAL AREA WITH RESPONSIBILITY ALONG WITH THE TAX DEPARTMENT. A DRAFT COPY OF THE RETURN IS PROVIDED TO THE CFO FOR REVIEW. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C A DISCLOSURE QUESTIONNAIRE IS SENT TO ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES. PERSONS REQUIRED TO REPORT, WHO HAVE NOT RETURNED QUESTIONNAIRES, WILL BE CONTACTED AND FOLLOW-UP WILL CONTINUE ON A REGULAR BASIS IN AN EFFORT TO RECEIVE COMPLETE AND ACCURATE RESPONSES FROM ALL PERSONS. THE INFORMATION DISCLOSED WILL BE USED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST AND TO ASSIST IN COMPLETING IRS QUESTIONNAIRES. THE DUTY TO IDENTIFY AND DISCLOSE POTENTIAL CONFLICTS OF INTEREST IS A DUTY THAT IS ONGOING. ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES SHALL IMMEDIATELY DISCLOSE SUCH POTENTIAL CONFLICT OR DUALITY OF INTEREST AS SOON AS THE INTEREST OCCURS. DISCLOSURE SHOULD BE MADE TO THE COVERED PERSON'S SUPERVISOR, DIRECTOR OF THE ORGANIZATION, OR THE BOARD CHAIR OF THE ORGANIZATION, AS APPLICABLE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION RELIES ON AN UNRELATED ORGANIZATION TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION BASED ON FAIR MARKET VALUE. THE COMPENSATION AND BENEFITS OF THE OTHER PERSONS LISTED ON FORM 990, PART VII WAS ESTABLISHED BY AN INDEPENDENT PERSON/COMMITTEE USING AN INDEPENDENT COMPENSATION CONSULTANT AND/OR COMPENSATION SURVEY OR STUDY FOR SIMILARLY QUALIFED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. COMPENSATION AND BENEFITS ARE BASED ON THE FAIR MARKET VALUE OF THE SERVICES PROVIDED TO THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 ST. LUKE'S HEALTH CARE FOUNDATION MAKES AVAILABLE TO THE PUBLIC THE ORGANIZATION'S BOARD OF DIRECTORS LIST ON ITS WEBSITE. FORM 990 TAX INFORMATION, CONFLICT OF INTEREST POLICY, AND WHISTLEBLOWER POLICY ARE AVAILABLE TO THE PUBLIC THROUGH ST. LUKE'S METHODIST HOSPITAL'S WEBSITE (WWW.STLUKESCR.ORG). CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,616,556. CHANGE IN BENEFICIAL INTEREST IN TRUSTS -70,079. TOTAL TO FORM 990, PART XI, LINE 5: -1,686,635. ST LUKE'S DEVELOPMENT COMPANY 1026 A AVENUE NE CEDAR RAPIDS IA 52402 421353658 LESSOR NONRESIDENTIAL REAL ESTATE IA ST LUKE'S HEALTH CARE FOUNDATION C 1558606 6256679 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ST LUKE'S DEVELOPMENT COMPANY A 12076 BASED ON GAAP, CASH, AND/OR FMV. SECTION 512(B)(13) CONTROLLED ENTITY SCHEDULE R, PART II, COLUMN (G) THE ORGANIZATION IS A MEMBER OF A CONSOLIDATED HEALTH SYSTEM AND HAS A COMMON PARENT ORGANIZATION, "IOWA HEALTH SYSTEM." FOR ENTITIES THAT ARE PART OF THE CONSOLIDATED HEALTH SYSTEM (WITH COMMON CONTROL) THE ATTRIBUTION RULES OF IRC SECTION 318 APPLY; MEANING THAT ALL ORGANIZATIONS ARE DEEMED TO HAVE CONTROL OF THE ORGANIZATIONS OWNED BY THE CONTROLLING ORGANIZATION. AS SUCH, WE ARE REPORTING ALL RELATED ORGANIZATIONS OF THE HEALTH SYSTEM IN PARTS II, III & IV. FOR PART V REPORTING, THE TRANSACTIONS DISCLOSED ARE THOSE BETWEEN THE DIRECTLY CONTROLLED PARENT-SUBSIDIARY ONLY. THE ORGANIZATION E-FILED A REQUEST FOR AN ADDITIONAL EXTENSION OF TIME TO FILE TO NOVEMBER 15, 2012, ON PART II OF FORM 8868. THE E-FILED EXTENSION WAS ACCEPTED BY THE IRS ON JULY 31, 2012; HOWEVER, THE IRS ISSUED NOTICE CP211A, DATED AUGUST 27, 2012, WITH AN INCORRECT DATE FOR PART II OF AUGUST 15, 2012 INSTEAD OF NOVEMBER 15, 2012. AS SUCH, THE ORGANIZATION RESPECTUFLLY REQUESTS THE ORGANIZATION'S RECORDS BE UPDATED ACCORDINGLY TO SHOW THIS FORM 990 AS BEING EXTENDED TO NOVEMBER 15, 2012, AND TIMELY FILED.