Civic Intelligence

Tri-State Health Services Foundation

EIN 34-1537408 • 501(c)3 • Steubenville, OH

Profile

A community partner dedicated to excellence in serving the health needs of the tri-state area.

One Ross Park BlvdSteubenville, OH 43952

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2016

Liabilities / Revenue

61st percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • <$500k nonprofits • Source year 2016

Net Margin

97th percentile

94%

Higher net margin than 97% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2016

Top Officer Pay

Score unavailable

No value available

No filing with officer rows is available for this organization yet.

Asset Growth

9th percentile

-100%

Faster asset growth than 9% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Revenue Growth

7th percentile

-87%

Faster revenue growth than 7% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2015 to 2016

Assets

Down

$0

Down $13,345,953 (-100%) from 2015

Liabilities

Down

$0

Down $32,294 (-100%) from 2015

Net Assets

Down

$0

Down $13,313,659 (-100%) from 2015

Revenue

Down

$44,940

Down $303,180 (-87%) from 2015

Expenses

Down

$2,880

Down $5,791 (-67%) from 2015

Net Income

Down

$42,060

Down $297,389 (-88%) from 2015

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$15M$10M$5.0M$0Assets 2015: $13,345,953Liabilities 2015: $32,294Net Assets 2015: $13,313,6592015Assets 2016: $0Liabilities 2016: $0Net Assets 2016: $02016

Highlighted filing

2016

Assets$0
Liabilities$0
Net Assets$0

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$400K$300K$200K$100K$0Revenue 2015: $348,120Expenses 2015: $8,671Net Income 2015: $339,4492015Revenue 2016: $44,940Expenses 2016: $2,880Net Income 2016: $42,0602016

Highlighted filing

2016

Revenue$44,940
Expenses$2,880
Net Income$42,060

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2016 to Jan 31, 2016
Signed
May 15, 2017
Return Version
2015v3.0
Gross Receipts
$44,940
Mission and Program Overview

Mission

A community partner dedicated to excellence in serving the health needs of the tri-state area.

Tri-State Foundation is a supporting organization of Tri-State Health Services, Inc., a 501(C)(3) organization, which conducts programs, such as Prime Time, a seniors health services assistance program.

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$13,340,724--
Cash and Non-Interest-Bearing Accounts$5,229--
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities$0--
Investments Program Related$0--
Land, Buildings, and Equipment, Net-$0-
Total Assets$13,345,953$0▼ $13,345,953
Other Assets Total$0$0→ $0
Liabilities
Accounts Payable and Accrued Expenses$32,294--
Other Liabilities$0$0→ $0
Total Liabilities$32,294$0▼ $32,294
Net Assets / Fund Balance
Unrestricted Net Assets$13,313,659--
Total Net Assets Fund Balance$13,313,659$0▼ $13,313,659
Total Liabilities and Net Assets / Fund Balance$13,345,953$0▼ $13,345,953
Compensation and Service Providers

Board Members and Trustees

NameTitle
-chairman
-PRESIDENT & CEO, Trinity Health System
-trustee
-secretary
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$44,940
Other Revenue
$0
Change in Net Assets
$42,060
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$2,880
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Service Investment Mgmnt Fees$2,805--$2,805
Other Expenses$75--$75
Total Functional Expenses$2,880$0$0$2,880
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 15 Process for Determining Compensation

During the tax year ended 6/30/2016, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Therefore, these questions are more appropriately answered as N/A.

Form 990, Part VI, Line 1A Delegate broad authority to A committee

Pursuant to the Bylaws of Tri-State Health Services Foundation, the Executive Committee is composed of the board chair, the board vice chair, the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. Each individual appointed to the Executive Committee shall serve for a term of one year or until his or her successor is duly appointed by the Board of Directors. The Executive Committee shall consist of only directors of the Corporation. Pursuant to the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors.

Form 990, Part VI, Line 6 Classes of members or stockholders

According to the bylaws of Tri-State Health Services Foundation the entity's sole member is Tri-State Health Services, an Ohio nonprofit organization.

Form 990, Part VI, Line 7A Members or stockholders electing members of governing body

According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation.

Form 990, Part VI, Line 11B Review of form 990 by governing body

The Tri-State Board of Trustees, represented by its Executive Committee, reviews the System's and related entities' Form 990s at their regular meeting. Each document is reviewed in detail, including each of the related schedules in their entirety. The Board's executive committee endorses the 990 filings. The board's executive committee reports on their review of the organization's 990s at its regular board of trustees meeting.

Form 990, Part VI, Line 12C Conflict of interest policy

Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must report the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential COI. If the C-CIRC determines that there is a potential or actual conflict of interest that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing person be allowed to participate in the activity or transaction subject to restrictions as outlined in the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and

Form 990, Part VI, Line 19 Required documents available to the public

The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.catholichealthinitiatives.org or at www.DACBOND.org.

Filing and Contact Details

Filer

Filer Name
Tri-State Health Services Foundation
EIN
34-1537408
Phone
7402837842
Address
One Ross Park Blvd, Steubenville, OH 43952

Signing Officer

Name
Dave Werkin
Title
CFO
Signed
2017-05-15
Discuss with paid preparer
Yes

Organization Details

Formed
1996
Legal Domicile
Oh
Voting Board Members
5
Independent Board Members
5
Employees
0
Volunteers
6

Preparer

Firm
Catholic Health Initiatives
Address
198 Inverness Drive West, Englewood, CO 80112
Preparer
Pamela Krohn
Phone
3032989100
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 3 Significant changes in program services

As of 2/1/2016, Tri-State Health Services Foundation was merged into Trinity Health Foundation.

Form 990, Part XI, Line 9 Other changes in net assets or fund balances

transfer to Trinity Health Foundation - -12865645;

Financial Statement Notes

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

Tri-State Health Services Foundation's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2016, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0Tri-State Health Services Foundation's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2016, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0As of 2/1/2016, Tri-State Health Services Foundation was merged into Trinity Health Foundation.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1During the tax year ended 6/30/2016, no officers, directors or trustees received compensation from the organization. Any executive compensation paid to officers, directors or trustees by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Therefore, these questions are more appropriately answered as N/A.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2Pursuant to the Bylaws of Tri-State Health Services Foundation, the Executive Committee is composed of the board chair, the board vice chair, the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. Each individual appointed to the Executive Committee shall serve for a term of one year or until his or her successor is duly appointed by the Board of Directors. The Executive Committee shall consist of only directors of the Corporation. Pursuant to the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3According to the bylaws of Tri-State Health Services Foundation the entity's sole member is Tri-State Health Services, an Ohio nonprofit organization.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5The Tri-State Board of Trustees, represented by its Executive Committee, reviews the System's and related entities' Form 990s at their regular meeting. Each document is reviewed in detail, including each of the related schedules in their entirety. The Board's executive committee endorses the 990 filings. The board's executive committee reports on their review of the organization's 990s at its regular board of trustees meeting.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must report the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential COI. If the C-CIRC determines that there is a potential or actual conflict of interest that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing person be allowed to participate in the activity or transaction subject to restrictions as outlined in the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.catholichealthinitiatives.org or at www.DACBOND.org.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8transfer to Trinity Health Foundation - -12865645;
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part III, Line 3 Significant changes in program services
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Line 15 Process for Determining Compensation
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Line 1a Delegate broad authority to a committee
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990, Part VI, Line 6 Classes of members or stockholders
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990, Part VI, Line 7a Members or stockholders electing members of governing body
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5Form 990, Part VI, Line 11b Review of form 990 by governing body
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6Form 990, Part VI, Line 12c Conflict of interest policy
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7Form 990, Part VI, Line 19 Required documents available to the public
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8Form 990, Part XI, Line 9 Other changes in net assets or fund balances
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