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ObjectId: 201403219349303480 - Submission: 2014-11-17
TIN: 16-1576637
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
Attach to Form 990.
See separate instructions.
Information about Schedule D (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
FAXTON ST LUKE'S HEALTHCARE
Employer identification number
16-1576637
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a)
Donor advised funds
(b)
Funds and other accounts
1
Total number at end of year
.........
2
Aggregate contributions to (during year)
...
3
Aggregate grants from (during year)
.....
4
Aggregate value at end of year
........
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control?
............
Yes
No
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit?
...................................
Yes
No
Part II
Conservation Easements.
Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Preservation of an historically important land area
Protection of natural habitat
Preservation of a certified historic structure
Preservation of open space
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a
Total number of conservation easements
.......................
2a
b
Total acreage restricted by conservation easements
..................
2b
c
Number of conservation easements on a certified historic structure included in (a)
.....
2c
d
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register
....................
2d
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year
4
Number of states where property subject to conservation easement is located
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds?
.............................
Yes
No
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
$
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)?
.......................................
Yes
No
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1
........................
$
(ii)
Assets included in Form 990, Part X
..............................
$
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1
..........................
$
b
Assets included in Form 990, Part X
...............................
$
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013
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Schedule D (Form 990) 2013
Page
2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
(continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
Public exhibition
d
Loan or exchange programs
b
Scholarly research
e
Other
c
Preservation for future generations
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?
........
Yes
No
Part IV
Escrow and Custodial Arrangements.
Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X?
....................................
Yes
No
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c
Beginning balance
.................................
1c
d
Additions during the year
..............................
1d
e
Distributions during the year
.............................
1e
f
Ending balance
...................................
1f
2a
Did the organization include an amount on Form 990, Part X, line 21?
.....................
Yes
No
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII
........
Part V
Endowment Funds.
Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)
Current year
(b)
Prior year
b (c)
Two years back
(d)
Three years back
(e)
Four years back
1a
Beginning of year balance
....
7,569,758
8,060,784
9,098,945
7,020,434
6,333,673
b
Contributions
........
c
Net investment earnings, gains, and losses
790,043
39,708
-1,071,182
2,522,730
1,370,443
d
Grants or scholarships
.....
e
Other expenditures for facilities
and programs
........
4,185,466
530,734
-33,021
444,219
683,682
f
Administrative expenses
....
g
End of year balance
......
4,174,335
7,569,758
8,060,784
9,098,945
7,020,434
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment
0 %
b
Permanent endowment
60.000 %
c
Temporarily restricted endowment
40.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:
Yes
No
(i)
unrelated organizations
........................
3a(i)
No
(ii)
related organizations
........................
3a(ii)
Yes
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
.........
3b
Yes
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a.
See Form 990, Part X, line 10.
Description of property
(a)
Cost or other basis (investment)
(b)
Cost or other basis (other)
(c)
Accumulated depreciation
(d)
Book value
1a
Land
.................
2,159,447
2,159,447
b
Buildings
................
112,451,276
75,270,832
37,180,444
c
Leasehold improvements
............
4,684,409
1,218,478
3,465,931
d
Equipment
................
172,773,301
123,331,943
49,441,358
e
Other
.................
7,537,581
3,382,416
4,155,165
Total.
Add lines 1a through 1e.
(Column (d) must equal Form 990, Part X, column (B), line 10(c).)
.......
96,402,345
Schedule D (Form 990) 2013
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Schedule D (Form 990) 2013
Page
3
Part VII
InvestmentsOther Securities.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b.
See Form 990, Part X, line 12.
(a)
Description of security or category
(including name of security)
(b)
Book value
(c)
Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
MUTUAL FUNDS INVESTMENT
38,646,440
F
(B)
COMMON STOCK INVESTMENT
5,085,322
F
(C)
CORPORATE OBLIGATIONS
34,985,552
F
(D)
CASH AND CASH EQUIVALENTS
60,732
F
Total.
(Column (b) must equal Form 990, Part X, col. (B) line 12.)
78,778,046
Part VIII
InvestmentsProgram Related.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c.
See Form 990, Part X, line 13.
(a)
Description of investment
(b)
Book value
(c)
Method of valuation:
Cost or end-of-year market value
Total.
(Column (b) must equal Form 990, Part X, col.(B) line 13.)
Part IX
Other Assets.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d.
See Form 990, Part X, line 15.
(a)
Description
(b)
Book value
(1)
OTHER ASSETS
4,588,858
(2)
DUE FROM AFFILIATES
1,005,866
(3)
UNAMORTIZED DEBT ISSUANCE COSTS
447,139
(4)
WC INSURANCE RECEIVABLE LT, NET
6,204,887
(5)
G&P INSURANCE RECEIVABLE LT, NET
12,818,689
(6)
ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET
6,883,800
Total.
(Column (b) must equal Form 990, Part X, col.(B) line 15.)
...........
31,949,239
Part X
Other Liabilities.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f.
See Form 990, Part X, line 25.
1.
(a)
Description of liability
(b)
Book value
Federal income taxes
2006 SERIES TAXABLE BONDS
10,475,000
CAPITAL LEASE OBLIGATIONS
15,716,609
UNREALIZED LOSS ON INTEREST RATE SWAPS
3,851,739
WC INSTURANCE RECEIVABLE ST/LT
3,627,030
G&P INSURANCE RECEIVABLE ST/LT
19,701,546
ESTIMATED SELF INSURED LIABILITIES
7,267,382
Total.
(Column (b) must equal Form 990, Part X, col.(B) line 25.)
60,639,306
2.
Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
..................................................
Schedule D (Form 990) 2013
Page 4
Schedule D (Form 990) 2013
Page
4
Part XI
Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1
Total revenue, gains, and other support per audited financial statements
.......
1
277,642,568
2
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a
Net unrealized gains on investments
..........
2a
b
Donated services and use of facilities
.........
2b
c
Recoveries of prior year grants
...........
2c
d
Other (Describe in Part XIII.)
............
2d
-950,086
e
Add lines
2a
through
2d
.....................
2e
-950,086
3
Subtract line
2e
from line
1
.....................
3
278,592,654
4
Amounts included on Form 990, Part VIII, line 12, but not on line
1
:
a
Investment expenses not included on Form 990, Part VIII, line 7b
.
4a
b
Other (Describe in Part XIII.)
...........
4b
c
Add lines
4a
and
4b
.......................
4c
0
5
Total revenue. Add lines
3
and
4c.
(This must equal Form 990, Part I, line 12.)
......
5
278,592,654
Part XII
Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1
Total expenses and losses per audited financial statements
...........
1
281,804,086
2
Amounts included on line 1 but not on Form 990, Part IX, line 25:
a
Donated services and use of facilities
..........
2a
b
Prior year adjustments
..............
2b
c
Other losses
................
2c
d
Other (Describe in Part XIII.)
............
2d
-950,086
e
Add lines
2a
through
2d
......................
2e
-950,086
3
Subtract line
2e
from line
1
.....................
3
282,754,172
4
Amounts included on Form 990, Part IX, line 25, but not on line
1:
a
Investment expenses not included on Form 990, Part VIII, line 7b
..
4a
b
Other (Describe in Part XIII.)
............
4b
c
Add lines
4a
and
4b
.......................
4c
0
5
Total expenses. Add lines
3
and
4c.
(This must equal Form 990, Part I, line 18.)
......
5
282,754,172
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference
Explanation
PART V, LINE 4:
PERMANENT ENDOWMENT FUNDS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS TO BE USED TO SUPPORT CHARITY CARE, HEALTH CARE SERVICES, SCHOLARSHIPS AND FACILITY MAINTENANCE. TEMPORARY ENDOWMENT FUNDS ARE DONOR CONTRIBUTIONS RESTRICTED BY THE DONORS FOR SPECIFIC PURPOSES.
PART X, LINE 2:
PART X, LINE 2: FSLH IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501C(3) OF THE INTERNAL REVENUE CODE. THE STANDARDS FOR ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IS TO ESTABLISH A RECOGNITION THRESHOLD AND MEASUREMENT FOR INCOME TAX POSITIONS RECOGNIZED IN A HOSPITALS FINANCE STATEMENTS. THESE STANDARDS HAD NO IMPACT ON THE ACCOMPANYING CONSOLIDATATED FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2010-2013.
PART XI, LINE 2D - OTHER ADJUSTMENTS:
LEGAL EXPENSE CREDIT FOR HAMELIN LAWSUIT -950,086.
PART XII, LINE 2D - OTHER ADJUSTMENTS:
LEGAL EXPENSE CREDIT FOR HAMELIN LAWSUIT -950,086.
Schedule D (Form 990) 2013
Additional Data
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