2024-05-15T11:50:34-05:00 2023-06-30 135565207 KPMG LLP 301 MAIN STREET SUITE 2150 BATON ROUGE LA 70801 990 2022-07-01 431992975 ST DOMINIC HEALTH SERVICES FOUNDATION INC STDO 6012006951 969 LAKELAND DRIVE JACKSON MS 391264699 SAM SCOTT TREASURER 6012006951 2024-05-14 1 SAM SCOTT 999009999 0 RYAN HOOKS P00746825 2253444000 2024-05-14 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z SAM SCOTT 969 LAKELAND DRIVE JACKSON MS 391264699 5044393 0 X WWW.STDOM.COM X 2002 MS SUPPORTS ST. DOMINIC HEALTH SERVICES & AFFILIATES THROUGH FUNDRAISING & GIVING INITIATIVES 23 21 0 21 0 0 1629443 776943 0 0 907481 357127 0 0 2536924 1134070 2025886 1275423 0 0 0 0 0 0 211213 164059 216464 2189945 1491887 346979 -357817 21460774 23584067 113069 1405287 21347705 22178780 X SEE SCHEDULE O 0 0 1275423 1275423 0 ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. FACILITATES FUNDRAISING IN SUPPORT OF THE MISSION OF ST. DOMINIC HEALTH SERVICES AND ITS AFFILIATES, ST. CATHERINE'S VILLAGE, COMMUNITY HEALTH SERVICES AND ST. DOMINIC JACKSON MEMORIAL HOSPITAL. GRANTS ARE MADE TO PROMOTE THE WELFARE OF THESE ORGANIZATIONS AND INCREASE THEIR USEFULNESS TO THE JACKSON, MISSISSIPPI COMMUNITY THEY SERVE. 1275423 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 23 21 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SAM SCOTT 6012006951 969 LAKELAND DRIVE JACKSON MS 392164699 AMY BOTELER BOARD MEMBER 0.50 0.00 X 0 0 0 BARTON LAMPTON BOARD MEMBER 0.50 0.00 X 0 0 0 BOBBY ARNOLD BOARD MEMBER 0.50 0.00 X 0 0 0 BRIAN JOHNSON BOARD MEMBER 0.50 0.00 X 0 0 0 C RALPH DANIEL III MD BOARD MEMBER 0.50 0.00 X 0 0 0 CHARLES POSTON BOARD MEMBER 0.50 0.00 X 0 0 0 CHERYL RULA BOARD MEMBER 0.50 0.00 X 0 0 0 D PAUL SEAGO MD BOARD MEMBER/PHYSICIAN 0.50 40.00 X 0 974725 34517 DICKENS Q FOURNET SECRETARY 0.50 0.00 X 0 0 0 DOUG RALSTON CHAIR 0.50 0.00 X X 0 0 0 JAMES HOUSE III MD BOARD MEMBER 0.50 0.00 X 0 0 0 JOE RICE BOARD MEMBER 0.50 0.00 X 0 0 0 JOSEPH GOODELL BOARD MEMBER 0.50 0.00 X 0 0 0 JULIE HERLIHY IMMEDIATE PAST CHAIR 0.50 0.00 X X 0 0 0 KENNY WILLIAMSON BOARD MEMBER 0.50 0.00 X 0 0 0 LARRY RATZLAFF BOARD MEMBER 0.50 0.00 X 0 0 0 MATT JAMES BOARD MEMBER 0.50 0.00 X 0 0 0 RITA MARTINSON VICE CHAIR 0.50 0.00 X X 0 0 0 SCOTT KASHMAN MARKET PRESIDENT 0.50 42.00 X X 0 610569 97937 SHIRLEY TUCKER BOARD MEMBER 0.50 0.00 X 0 0 0 SISTER DOROTHEA SONDGEROTH BOARD MEMBER 0.50 41.75 X 0 0 0 TRISH DUNCAN BOARD MEMBER 0.50 0.00 X 0 0 0 TRUDY LIPSCOMB BOARD MEMBER 0.50 0.00 X 0 0 0 KAY MCREE EXECUTIVE DIRECTOR 1.00 40.00 X 0 226098 23790 SAM SCOTT SVP, CFO 0.50 41.75 X 0 484817 32087 LESTER DIAMOND FORMER PRESIDENT 0.00 0.00 X 0 531654 0 0 2827863 188331 0 1 1 0 0 776943 776943 214932 214932 4052518 3910323 142195 142195 142195 1134070 0 0 357127 1275423 1275423 129279 129279 23996 23996 52571 52571 5367 5367 4765 4765 486 486 1491887 1275423 5251 211213 5039457 6734558 2969758 1944212 15000 15000 15000 13436559 14890297 21460774 23584067 2288 5100 110781 1400187 113069 1405287 X 6851499 7647253 14496206 14531527 21347705 22178780 21460774 23584067 -357817 1188892 0 X 0 1 X 1 0 X 938193 1973905 3125330 1629443 776943 8443814 938193 1973905 3125330 1629443 776943 8443814 2009176 6434638 234 54037 143898 119271 214932 532372 8976186 0.71690 0.72280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14906739 784009 542516 1694848 14538416 16140982 2150275 -154861 3229657 14906739 18534970 3100029 1128528 6622545 16140982 16584393 1991323 57589 98335 18534970 15707143 898388 281234 302372 16584393 1.00000 0 0 15000 15000 15000 INVESTMENTS HELD BY FMOLHS 14890297 F 14890297 DUE TO/FROM AFFILIATES 1400187 1400187 X 3109293 1188892 810532 1999424 1109869 23993 208 24201 1134070 2278426 810532 810532 1467894 23993 23993 1491887 PART X, LINE 2: ASC 740 (FIN 48) FOOTNOTE FMOLHS RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. NO RESERVES FOR UNCERTAIN TAX POSITIONS HAVE BEEN RECORDED. PART XI, LINE 4B - OTHER ADJUSTMENTS: MISC ADJUSTMENT 208. PART X, LINE 2: THE ENDOWMENT FUNDS SUPPORT SPECIFIC PROJECTS, PROGRAMS AND ENTITIES WITHIN ST. DOMINIC'S AND ST. CATHERINE'S VILLAGE. 1 ST DOMINIC JACKSON MEMORIAL HOSPITAL 969 LAKELAND DRIVE JACKSON MS 39202 640303091 501(C)(3) 55000 0 GENERAL ASSISTANCE AND SENIOR CARE ST CATHERINE'S VILLAGE 200 DOMINICAN DRIVE MADISON MS 39110 640714997 501(C)(3) 174496 0 GENERAL ASSISTANCE 2 PART I, LINE 2: THE FOUNDATION'S LEADERSHIP STAYS IN CONTACT WITH THE ORGANIZATION RECEIVING FUNDS AND RECEIVES FOLLOW-UP REPORTS ON THE OUTCOME OF THE PROJECT. MOST ORGANIZATIONS ARE ANNUAL RECIPIENTS, SO THE FOUNDATION RECEIVES THE FOLLOW-UP REPORT FOR THE PREVIOUS YEAR ALONG WITH THE REQUEST FOR THE CURRENT YEAR. IN ADDITION TO PROVIDING FINANCIAL SUPPORT, MANY OF THE ORGANIZATIONS HAVE BOARD MEMBERS OR VOLUNTEERS THAT ARE EMPLOYEES OF ONE OF THE ST. DOMINIC AFFILIATES. THE COMMITTEE ALSO RECEIVES FEEDBACK FROM THESE INDIVIDUALS ON THE ACTIVITIES OF THE GRANTEE ORGANIZATION. 1 1 0 0 0 0 0 0 0 D PAUL SEAGO MD BOARD MEMBER/PHYSICIAN 0 773953 0 93597 0 107175 0 15250 0 19267 0 1009242 0 0 SCOTT KASHMAN MARKET PRESIDENT 0 499303 0 108077 0 3189 0 70852 0 27085 0 708506 0 0 LESTER DIAMOND FORMER PRESIDENT 0 0 0 0 0 531654 0 0 0 0 0 531654 0 0 SAM SCOTT SVP, CFO 0 321567 0 157491 0 5759 0 14175 0 17912 0 516904 0 0 KAY MCREE EXECUTIVE DIRECTOR 0 204828 0 20428 0 842 0 11597 0 12193 0 249888 0 0 PART I, LINE 3: THE FMOL HEALTH SYSTEM INC. BOARD OF DIRECTORS DESIGNATES A COMPENSATION COMMITTEE, MADE UP OF INDEPENDENT BOARD MEMBERS, TO REVIEW AND SET COMPENSATION ANNUALLY. THE COMPENSATION COMMITTEE OBTAINS AND RELIES UPON COMPARABLE DATA INCLUDING A COMPENSATION STUDY/SURVEY FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE REVIEWS COMPENSATION PACKAGES AND APPROPRIATE COMPENSATION IS DETERMINED AND APPROVED. THE BASIS FOR MAKING SUCH DETERMINATION IS DOCUMENTED BY THE COMPENSATION COMMITTEE. PART I, LINE 4A: THREE OFFICERS ARE ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 18 MONTHS. NO PAYMENTS WERE MADE UNDER THE PLAN IN THE CURRENT YEAR. ONE FORMER OFFICER IS ENTITLED TO A SEVERANCE BENEFIT. THE PAYOUT OF SUCH BENEFIT IS REMOTE AS IT IS EFFECTIVE ONLY FOR A TERMINATION OF EMPLOYMENT WITHOUT CAUSE, FOR GOOD REASON OR DUE TO CHANGE OF CONTROL. IF TRIGGERED, THE EMPLOYEE WOULD BE PAID HIS/HER BASE SALARY AND PROVIDED RETIREMENT AND WELFARE BENEFITS FOR AN ENTITLEMENT PERIOD. THE ENTITLEMENT PERIOD IS 24 MONTHS. LESTER DIAMOND RECEIVED A PAYMENT OF $531,654 IN THE CURRENT YEAR. PART I, LINE 4B: FMOLHS MAINTAINS THREE UNFUNDED DEFERRED COMPENSATION PLANS WHICH MEET THE REQUIREMENTS OF IRC SECTION 457(F) AND IRC SECTION 409A. THE PLANS PROVIDES FOR COMPENSATION TO BE DEFERRED AND PAID UPON THE OCCURRENCE OF CERTAIN EVENTS SUCH AS TERMINATION WITHOUT CAUSE, DISABILITY, DEATH OR ATTAINMENT OF A SPECIFIC PAYMENT DATE. PARTICIPATION IN THE PLANS IS LIMITED TO CERTAIN EXECUTIVES AND IS SUBJECT TO APPROVAL OF FMOLHS BOARD OF DIRECTORS OR A DESIGNATED COMMITTEE OF SUCH BOARD. NO ONE LISTED IN PART VII, SECTION A RECEIVED A PAYMENT IN THE CURRENT YEAR. X 4 50301 FMV 0 1 0 PART I, COLUMN (B): PART I, LINE 9, COLUMN B THE FIGURES REPORTED IN PART I, LINE 9, COLUMN B REPRESENT THE NUMBER OF DONATION OCCURANCES. A NONCASH CONTRIBUTION WAS MADE IN FULFILLMENT OF A PRIOR YEAR PLEDGE. THE FULL FAIR MARKET VALUE OF THE CONTRIBUTION IS $767,316. HOWEVER, ONLY THE AMOUNT REFLECTED IN THE FINANCIAL STATEMENTS FOR THE YEAR ENDING 6/30/23 IS REPORTED HERE. THE REPORTED AMOUNT REPRESENTS THE INCREASE IN THE NET PRESENT VALUE OF THE PLEDGED AMOUNT. FORM 990, PART III, LINE 1: INSPIRED BY THE VISION OF ST. FRANCIS AND IN THE TRADITION OF THE ROMAN CATHOLIC CHURCH, WE EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO GOD'S PEOPLE, ESPECIALLY THOSE MOST IN NEED. WE CALL FORTH ALL WHO SERVE IN THIS HEALTHCARE MINISTRY, TO SHARE THEIR GIFTS AND TALENTS TO CREATE A SPIRIT OF HEALING - WITH REVERENCE AND LOVE FOR ALL OF LIFE, WITH JOYFULNESS OF SPIRIT, AND WITH HUMULITY AND JUSTICE FOR ALL THOSE ENTRUSTED TO OUR CARE. WE ARE, WITH GOD'S HELP, A HEALING AND SPIRITUAL PRESENCE FOR EACH OTHER AND FOR THE COMMUNITIES WE ARE PRIVILEGED TO SERVE. FORM 990, PART VI, SECTION A, LINE 6 ST. DOMINIC HEALTH SERVICES, INC. IS THE SOLE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE FOUNDATION'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC., HAVE THE AUTHORITY TO APPROVE THE ELECTION OF THE CHAIR OF THE BOARD, THE VICE-CHAIR OF THE BOARD, THE PRESIDENT OF THE FOUNDATION, AND ALL OTHER DIRECTORS AND OFFICERS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE RESERVED POWERS TO FMOL HEALTH SYSTEM, INC. ARE AS FOLLOWS: I. TO CHANGE PHILOSOPHY, OBJECTIVES AND PURPOSES OF CORPORATION. II. TO APPOINT OR REMOVE THE MEMBERS OF THE BOARD OF TRUSTEES AND OFFICERS OF THE CORPORATION. III. TO AMEND, ALTER, MODIFY OR REPEAL THE ARTICLES OF INCORPORATION AND BY LAWS OF THE CORPORATION. IV. TO AUTHORIZE MERGER, CONSOLIDATION, OR AFFILIATION, OR PARTICIPATE IN JOINT VENTURES. V. TO DISSOLVE AND TO DISTRIBUTE ASSETS OF THE CORPORATION. VI. TO APPOINT AND/OR TERMINATE WITH OR WITHOUT CAUSE THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. VII. TO ACQUIRE, PURCHASE, SELL, LEASE, TRANSFER, OR ENCUMBER ANY IMMOVABLE PROPERTY ON BEHALF OF THE CORPORATION. VIII. TO ADD TO OR INCUR LONG-TERM DEBT IN EXCESS OF $5 MILLION BY THE CORPORATION. IX. TO APPOINT THE FISCAL AUDITOR FOR THE CORPORATION. X. TO APPROVE ANY INCREMENT OR ADDITION TO THE CAPITAL DEBT OR EFFORTS TO RENEGOTIATE, MODIFY OR CHANGE THE EXISTING CAPITAL DEBT OBLIGATIONS OF THE CORPORATION. XI. TO APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. XII. TO APPROVE A STRATEGIC BUSINESS PLAN OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B AFTER PREPARATION AND REVIEW OF FORM 990 BY KPMG LLP, THE TAXPAYER'S TAX ADVISORS, ONE OR MORE MEMBERS OF SENIOR MANAGEMENT REVIEWS THE RETURN. GOVERNING BODY IS PROVIDED A COPY OF THE RETURN ELECTRONICALLY PRIOR TO THE FILING DATE AND IS GIVEN AN OPPORTUNITY TO REVIEW AND PROVIDE COMMENTS TO MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS RECEIVE A COPY OF THE POLICY AND FORM FOR REPORTING EACH YEAR AT THE FIRST MEETING OF THE YEAR. FORMS ARE REVIEWED BY THE PRESIDENT AND ANY CONFLICTS SHARED WITH THE BOARD CHAIR. PERSONS WITH CONFLICTS OF INTERESTS ABSTAIN FROM ANY DECISIONS WHERE THE CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION DOES NOT COMPENSATE ANY OFFICERS OR EMPLOYEES. ALL COMPENSATION IS PAID BY THE FOUNDATION'S SOLE MEMBER, ST. DOMINIC HEALTH SERVICES, INC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SECTION 1.263(A)-3(N) ELECTION - BOOK CONFORMITY ELECTION: ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. IS MAKING THE ELECTION UNDER TREAS. REG. 1.263(A)-3(N) TO CAPITALIZE THOSE REPAIR AND MAINTENANCE COSTS THAT IT TREATS AS CAPITAL IMPROVEMENTS ON ITS BOOKS AND RECORDS FOR THE TAX YEAR ENDED JUNE 30, 2023. SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION: ST. DOMINIC HEALTH SERVICES FOUNDATION, INC. HEREBY MAKES THE DE MINIMIS SAFE HARBOR ELECTION UNDER SECTION 1.263(A)-1(F) OF THE TREASURY REGULATIONS, EFFECTIVE ONLY FOR THE TAX YEAR ENDING JUNE 30, 2022. TAXPAYER HAS AN APPLICABLE FINANCIAL STATEMENT FOR THE YEAR OF THE ELECTION. THIS ELECTION PERMITS THE TAXPAYER TO DEDUCT FOR TAX PURPOSES ANY ITEM DEDUCTED UNDER ITS BOOK POLICY THAT DOES NOT EXCEED $5,000 PER INVOICE (OR PER ITEM, AS SUBSTANTIATED BY THE INVOICE) OR ITEMS HAVING AN ECONOMIC USEFUL LIFE OF TWELVE MONTHS OF LESS AS DESCRIBED IN SECTION 1.263(A)-1(F)(1)(I). 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