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FRANCISCAN SERVICES SELF INS TRUST FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FRANCISCAN SERVICES SELF INS TRUST FUND (EIN 34-6895492)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201133199349301823
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-15T08:17:24-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line141 S HIGH ST 1100 HUNTINGTON CTRAddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN346895492EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FRANCISCAN SERVICES SELF INS TRUST FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFRANNameControl
Phone4198828373Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line16832 CONVENT BLVDAddressLine1
CitySYLVANIACity
StateOHState
ZIP Code43537ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROBERT TRACZName
TitleCFOTitle
Date Signed2011-11-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone6142245678Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJames W PopeNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line16832 Convent BlvdAddressLine1
CitySylvaniaCity
StateOHState
ZIP Code43560ZIPCode
FieldValueIRS element (for citing)
Gross Receipts74229158GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1987YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionThe self insurance program provides professional liability malpractice and comprehensive general liability insurance coverage on a group basis.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5023878ProgramServiceRevenuePriorYear
Program Service Revenue CY1735856ProgramServiceRevenueCY
Investment Income Prior Year-676203InvestmentIncomePriorYear
Investment Income Current Year2812719InvestmentIncomeCurrentYear
Other Revenue Prior Year12407OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year4360082TotalRevenuePriorYear
Total Revenue Current Year4548575TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3286451OtherExpensePriorYear
Other Expenses Current Year9645388OtherExpensesCurrentYear
Total Expenses Prior Year3286451TotalExpensesPriorYear
Total Expenses Current Year9645388TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1073631RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-5096813RevenuesLessExpensesCY
Total Assets BOY44018325TotalAssetsBOY
Total Assets EOY42890534TotalAssetsEOY
Total Liabilities BOY3826013TotalLiabilitiesBOY
Total Liabilities EOY8219731TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY40192312NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY34670803NetAssetsOrFundBalancesEOY
Mission DescriptionThe Self Insurance Program provides professional liability MALPRACTICE AND COMPREHENSIVE GENERAL LIABILITY INSURANCE COVERAGE ON A GROUP BASIS TO FRANCISCAN SERVICES CORPORATION AND ITS AFFILIATES, ALL TAX-EXEMPT 501(C)(3) ORGANIZATIONS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense8823589Expense
Revenue1735856Revenue
DescriptionTO PROVIDE PROFESSIONAL AND COMPREHENSIVE LIABILITY INSURANCE FUND FOR RELATED TAX-EXEMPT ORGANIZATIONS.Description
Total Program Service Expense8823589TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109651NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRobert TraczNamePerson
Telephone Number4198828373TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16832 Convent BlvdAddressLine1
CitySylvaniaCity
StateOHState
ZIP Code43560ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerInstitutional TrusteeInstitutionalTrustee
Sister Mary Jo Mike OSF
Director1.0X000
Willy F Kuehn
Director1.0X000
Sister Laureen M Painter OSF
Director1.0X000
Steven L Salman
Vice Chairperson1.0X000X
Sister Mary Ann Grzeskowiak OSF
Director1.0X000
Sisten Nancy Linenkugel OSF
Secretary1.0X000X
Patricia C Birch
Director1.0X000
John L Hall MD
Chairperson1.0X000X
James W Pope
President (As Of 8/2010)1.0X022592314552X
William R Waters
Treasurer1.0X0622280257170X
Dennis Wolters
Director1.0X000
KeyTrust Company of Ohio NA
Director1.0000X
John W OConnell
Former President1.00636607406576X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1484810TotalReportableCompFrmRltdOrgs
Total Other Compensation678298TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WHITEHURST HARKNESS BREES CHENG P
5113 Southwest Parkway Ste 150AUSTINTX78735LEGAL SERVICES1210000
DAVIS WILKERSON
PO BOX 2283SAN ANTONIOTX78249LEGAL SERVICES280257
CATHOLIC HEALTH INITIATIVES
3400 OLYMPIC BLVD SUITE 400TEXARKANAKY41018LEGAL SERVICES100000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionInsurance PremiumsDescription
Business Code525100BusinessCode
Total Revenue Column1735856TotalRevenueColumn
Related Or Exempt Function Income1735856RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue1735856TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1905131TotalRevenueColumn
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,905,131ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities70588171Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities69680583Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities907588Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column907588TotalRevenueColumn
Exclusion$907,588ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4548575TotalRevenueColumn
Related Or Exempt Function Income1735856RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,812,719ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total100000Total
Management And General100000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total590876Total
Program Services590876ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total237997Total
Management And General237997ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total483802Total
Management And General483802ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total0Total

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total1789569Total
Program Services1789569ProgramServices

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionPROVISION FOR INSUR CLAIMSDescription
Total6443144Total
Program Services6443144ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9645388Total
Program Services8823589ProgramServices
Management And General821799ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY398532EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3792877BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5304349BOY
EOY5228917EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY618931BOY
EOY470660EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY32756680BOY
EOY36680472EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY1380757BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY164731BOY
EOY111953EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY44018325BOY
EOY42890534EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY15000BOY
EOY24084EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY3811013BOY
EOY8195647EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3826013BOY
EOY8219731EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY40192312BOY
EOY34670803EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY40192312BOY
EOY34670803EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44018325BOY
EOY42890534EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-5096813ReconcilationRevenueExpenses
Reconcilation Other Changes-424696ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Franciscan Services CorporationBusinessNameLine1
FieldValueIRS element (for citing)
EIN341412964EIN
Type Of Organization01TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$1,735,856Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts1735856SumOfAmounts
General ExplanationTHE ORGANIZATION IS ORGANIZED FOR THE PURPOSE OF SUPPORTING HOSPITAL, EDUCATIONAL, AND CHARITABLE ENTITIES SPONSORED BY THE SISTERS OF ST FRANCIS OF THE CONGREGATION OF OUR LADY OF LOURDS OF SYLVANIA, OH.GeneralExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
James W Pope
01918370003408600014552024047500
John W OConnell
054590500090702038683901973701043183037833
William R Waters
032756400029471602236320335380879450043634

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental Compensation InformationIdentifier
ExplanationJOHN O'CONNELL AND WILLIAM WATERS RECEIVED A PAYMENT FROM THE FSC SERP. JOHN O'CONNELL'S TOTAL PAYMENT WAS $37,833. WILLIAM WATER'S TOTAL PAYMENT WAS $124,542. WHICH INCLUDED A TAX GROSS UP OF $80,908. MR. O'CONNELL AND MR. WATERS PARTICIPATE IN A SERP. THE CURRENT YEAR CONTRIBUTIONS WERE $337,242 AND $194,999 RESPECTIVELY.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERSFORM 990, PART VI, QUESTION 6THE FRANCISCAN SERVICES SELF INSURANCE TRUST HAS FRANCISCAN SERVICES CORPORATION AS ITS MEMBER ORGANIZATION.
DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPROVALFORM 990, PART VI, QUESTION 7BONLY A CHANGE IN BUSINESS PURPOSES.
DESCRIPTION OF THE PROCESS USED BY MGT &/OR GOVERNING BODY TO REVIEW 990FORM 990, PART VI, QUESTION 11ATHE FORM 990 WAS MADE AVAILABLE FOR ALL BOARD MEMBERS TO REVIEW PRIOR TO ITS FILING WITH A FOLLOW-UP DISCUSSION WITHIN THE BOARD TO OCCUR AT ITS NOVEMBER 16, 2011 BOARD MEETING.
DOCUMENT RETENTION, WHISTLEBLOWER AND CONFLICT OF INTEREST POLICIESFORM 990, PART VI, QUESTIONS 12, 13, & 14FRANCISCAN SERVICES CORP SELF INSURANCE HAS A DOCUMENT RETENTION POLICY, BUT IT DOES NOT YET HAVE A WHISTLEBLOWER POLICY OR A FORMAL CONFLICT OF INTEREST POLICY THAT HAS BEEN ADOPTED BY THE BOARD. THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF DRAFTING THE LATTER TWO POLICIES SO THAT THEY WILL BE IN PLACE BY NEXT YEAR.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTFORM 990, PART VI, QUESTION 12CALL BOARD MEMBERS COMPLETE THE FORM AND THEN THEY ARE REVIEWED FOR ANY POTENTIAL CONFLICTS. BOARD MEMBERS STATE THAT THEY WILL REPORT IMMEDIATELY IN WRITING, ANY CONFLICT OF INTEREST THAT ARISES IN THE FUTURE. IN ADDITION, ALL BOARD MEMBERS COMPLETE AN ANNUAL QUESTIONAIRE ADDRESSING BUSINESS AND FAMILY RELATIONSHIPS AMONG BOARD MEMBERS, OFFICERS, KEY EMPLOYEES AND BETWEEN SUCH INDIVIDUALS AND THE ORGANIZATION. THE PRESIDENT/CEO REVIEWS ANY CONFLICTS AND MEMBERS ABSTAIN FROM VOTING AND LEAVE THE ROOM DURING VOTING IF A TRANSACTION IS A CONFLICT.
AVAILABILITY OF GOV DOCS & FINANCIAL STATEMENTS TO GEN PUBLICFORM 990, PART VI, QUESTION 19THEY ARE AVAILABLE AT OUR OFFICE UPON REQUEST.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, QUESTION 5CHANGES CONSIST OF: UNREALIZED GAINS ON INVESTMENTS $ 956,061 TRANSFER OF INVESTMENT TO FRANCISCAN SERVICES CORPORATION $(1,380,757) ----------- $( 424,696)
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:James W Pope TITLE:President (As Of 8/2010) HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:William R Waters TITLE:Treasurer HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:John W OConnell TITLE:Former President HOURS:40

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
TRINITY HEALTH SERVICES CORP
700 MEDICAL PARKWAYBRENHAMTX77833742605157HOLDING COMPTX501(c)(3)11aFSC
ST JOSEPH SERVICES CORPORATION
2801 FRANCISCAN DRIVEBRYANTX77802742455161GOVERNANCETX501(c)(3)11-TYPE IFSC
ST JOSEPH REGIONAL HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802741282696HEALTH CARETX501(c)(3)3SJSC
BURLESON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802742759890HEALTH CARETX501(c)(3)3SJSC
MADISON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802742761145HEALTH CARETX501(c)(3)3SJSC
ST JOSEPH MANOR
2801 FRANCISCAN DRIVEBRYANTX77802742847594NURSING CARETX501(c)(3)9SJSC
BURLESON ST JOSEPH MANOR
2801 FRANCISCAN DRIVEBRYANTX77802742913931NURSING CARETX501(c)(3)9SJSC
ST JOSEPH FOUNDATION
2801 FRANCISCAN DRIVEBRYANTX77802742351158FUND RAISINGTX501(c)(3)11-TYPE ISJSC
ST JOSEPH PHYSICIAN ASSOCIATES
2801 FRANCISCAN DRIVEBRYANTX77802203159302PHY PRACTICETX501(c)(3)3SJSC
FRANCISCAN SHELTERS DBA BETHANY HOUSE
6832 CONVENT BLVDSYLVANIAOH43560341612437D.V SHELTEROH501(c)(3)1FSC
SOPHIA CENTER
6832 CONVENT BLVDSYLVANIAOH43560341761656MENTAL HLTHOH501(c)(3)9FSC
TRINITY COMMUNITY MEDICAL CENTER
700 MEDICAL PARKWAYBRENHAMTX77833742519752HOSPITALTX501(c)(3)3THSC
SISTERS OF ST FRANCIS
6832 CONVENT BLVDSYLVANIAOH43560344450609RELIGIOUSOH501(c)(3)RELIGIOUSNA
FRANCISCAN SERVICES CORP
6832 CONVENT BLVDSYLVANIAOH43560341412964CHURCH ORGOH501(c)(3)1NA
FRANCISCAN LIVING COMMUNITIES
6832 CONVENT BLVDSYLVANIAOH43560341892096MGT SUPPORTOH501(c)(3)11-TYPE IFSC
ST LEONARD
8100 CLYO RDCENTERVILLEOH45458341940863LT CARE FCLTOH501(c)(3)9FLC
ST LEONARD FOUNDATION
8100 CLYO RDCENTERVILLEOH45458320102715FUND RAISINGOH501(c)(3)7FLC
PROVIDENCE CARE CENTER
2025 HAYES AVESANDUSKYOH44870341658625LT CARE FCLTOH501(c)(3)9FLC
THE COMMONS OF PROVIDENCE
5000 PROVIDENCE DRSANDUSKYOH44870341826097ASSISTED LIVOH501(c)(3)9PCC
PROVIDENCE RESIDENTIAL COMM CORP
5055 PROVIDENCE DRSANDUSKYOH44870341896807INDEPNDT LIVOH501(c)(3)9PCC
Providence Care Centers
2023 HAYES AVESANDUSKYOH44870341826099FIN SUPPORTOH501(c)(3)7FLC
TRINITY CARE CENTER
400 E SAYLESBRENHAMTX77833742663229LT CARE FCLTTX501(c)(3)9THSC
MADONNA MANOR
2344 AMSTERDAM RDVILLA HILLSKY41017610654635LT CARE FCLTKY501(c)(3)9FLC
FRANCISCAN CARE CENTER SYLVANIA
4111 HOLLAND SYLVANIA RDTOLEDOOH43623341931806LT CARE FCLTOH501(c)(3)9FLC
ST CLARE COMMONS
6832 CONVENT BLVDSYLVANIAOH43560270163752LT CARE FCLTOH501(c)(3)9FLC
ROSARY CARE CENTER
6832 CONVENT BLVDSYLVANIAOH43560341931795LT CARE FCLTOH509(A)(3)9FLC
FRANCISCAN PROPERTIES INC
6832 CONVENT BLVDSYLVANIAOH43560341412966SR HOUSINGOH501(C)(3)9FLC
TRINITY HEALTH SERVICES FOUNDATION
700 MEDICAL PARKWAYBRENHAMTX77833742460815FUND RAISINGTX501(c)(3)7THSC

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ST LEONARD CENTER LIMITED PARTNERSHIPBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line188 E BROAD STREET STE 1800AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
EIN311481761EIN
Primary ActivityLOW INCOME RENTPrimaryActivity
Legal Domicile StateOHLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeINVESTPredominantIncomeType
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnertrueGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
ALLIANCE HLTH PROVIDERS OF BRAZOS VALLEY
2801 FRANCISCAN DRIVEBRYANTX77802742466914PHYS HOSP ORGTXNAC
TAU ENTERPRISES
2801 FRANCISCAN DRIVEBRYANTX77802742544009OFFICE BLDG RENTTXNAC
ST JOSEPH PHYSICIAN ALLIANCE
2801 FRANCISCAN DRIVEBRYANTX77802742764039COORD EMPL INSURTXNAC
ST LEONARD CENTER 1 INC
8100 CLYO ROADCENTERVILLEOH45458311481764LOW INCOME RENTOHNAC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ST JOSEPH HEALTH SYSTEM
K3695922
FRANCISCAN LIVING COMMUNITIES
K208763