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    For the main analysis of nursing home staffing, the Center for Public Integrity downloaded the 2012 Medicare cost reports for skilled nursing facilities. The Center extracted data about the number of resident days and the number of hours paid according to staffing position and divided the total number of hours paid by the number of resident days to get an average daily level of staffing by position, as well as total staffing.  From there the Center connected the results of that calculation with 2012 data it had downloaded from the Nursing Home Compare website and calculated which dataset reported the higher staffing level for each direct care position, and for total staffing.

    The Center modeled its analysis on a recommendation from Charlene Harrington, professor emeritus of nursing at the University of California, San Francisco,  and on a peer-reviewed article by Catherine Hawes, Bita Kash and Charles Phillips that appeared in the August 2007 edition of The Gerontologist. The Center used data from the Centers for Medicare and Medicaid Services to calculate the number of standard survey inspections for each year from 2008 to 2012, and used Nursing Home Compare to compute the difference in the number of nursing homes in those two years.   

    For the piece on homes that ‘do staffing right,’ the Center identified those homes which received a 5-star overall rating from Nursing Home Compare and which had less than a 10 percent difference between the staffing levels from Nursing Home Compare and the daily average calculated through the cost reports for each staffing position, and for total staffing.

    For a piece on racial disparities the Center connected data from Vincent Mor of Brown University that contained facility-level information about nursing home residents' age, entering sickness, activities of daily living, racial composition and admissions per bed with the previous data set.The Center also used the Area Health Resource File to include the degree to which an area was urban or rural, and did a Herfindahl-Hirschman Index analysis to assess the relative amount of market concentration by county, city and zip code.

    It is important to note that the analysis was based on hours paid, not hours worked. Hours paid includes vacation and sick time, so is often higher than hours worked. As a result, the Center's findings on staffing discrepancies are conservative ones.

    For a piece on HUD loan guarantees for poorly-rated nursing homes, the Center looked at homes that had received HUD-backed mortgages during the years 2009 to August 2014, and then looked through ratings data from Nursing Home Compare to determine the overall quality rating those facilities received the month before they received the HUD-guaranteed loan. The Center used the ratings for December 2013 to evaluate nursing homes that received HUD-backed mortgages in February and March 2014. For the homes that received loans in April through August 2014, the Center used ratings data from April 2014. The Center then looked at mortgage data from HUD from 2001 to 2012 to determine the number of facilities among the 1-star homes with HUD-backed mortgages that had received an earlier loan.

    Jeff Kelly Lowensteinhttp://www.publicintegrity.org/authors/jeff-kelly-lowensteinBen Wiederhttp://www.publicintegrity.org/authors/ben-wiederhttp://www.publicintegrity.org/2014/11/12/16256/methodology-our-nursing-homes-investigation

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    Administrator Angela Buckland regularly walks the halls of the Woodview Healthcare nursing home in Fort Wayne, Indiana, to monitor how well residents are being treated.

    It’s just one part of a resident-first philosophy that includes quarterly satisfaction surveys, a confidential suggestion box and the inclusion of family members in the care planning process.

    The facility has “a team approach with everyone,” said Buckland, who has been an administrator since 2006. The staff at Woodview are a critical element of the team, she said, and the home maintains a consistent staffing level throughout the entire year. 

    In 2012 that consistency in staffing contributed to Woodview’s earning the top rating from the federal government for overall quality — a 5-star score on a 5-star scale from Nursing Home Compare, a website the government uses to help the public comparison shop for  nursing homes. Consistency is especially important because critics believe many homes “staff up” just before annual inspections in order to earn a higher rating from the federal government. Nursing home administrators and a leading industry group deny those charges.

    Woodview was one of four dozen nursing homes nationwide that had both consistent staffing levels and a five-star rating, according to an analysis by the Center for Public Integrity. The Center’s analysis of more than 10,000 nursing homes found consistently higher levels of reported staffing, particularly among registered nurses, on the public website Nursing Home Compare than the average daily levels calculated through Medicare cost reports that are largely out of public view.

    In 2005 the Centers for Medicare and Medicaid Services, the agency responsible for nursing home oversight, said the Medicaid cost reports that have much of the same information as the Medicare documents are generally more accurate than the self-reported data found on Nursing Home Compare. 

    The Center looked at a range of variables, including size, occupancy rate, ownership status and the percentage of days paid for by Medicaid. Those four dozen top-rated nursing homes differed little from the rest of the facilities on many of these variables, but the average staffing levels for registered nurses at these top-rated homes were about 50 percent higher than the average for all homes, according to the Center’s analysis.

    The total daily staffing levels at those top-rated homes were about 4.1 hours per resident per day, the Center’s analysis of cost reports data found.

    Robyn Grant, director of policy at the Consumer Voice for Quality Long-Term Care, the nation’s top nursing-home advocacy group, said the five-star rating system has some limitations but asserted that the top-rated nursing home providers nevertheless deserve praise for their staffing levels and quality of care.

    “[These providers] can and should be models for the others. They show us it can be done within the current system without receiving additional funding,” said Grant.

    A number of academic studies have found that staff continuity and the amount of care, particularly from registered nurses, can play a critical role in residents’ quality of care. Greater continuity of care is associated with residents’ having better health outcomes, the studies said.

    Jack Wagoner, administrator of the Carlton Shores Health and Rehabilitation Center in Daytona Beach, Florida, said several of the nurses at his five-star facility were long-time employees who started in other jobs — certified nursing assistants who had participated in the company’s tuition reimbursement policy. These opportunities for professional training and advancement contributed to greater stability and a lower-than-average turnover rate among nurse assistants,he said.

    Wagoner estimated that the level of aide turnover at Carlton Shores in the past year was between 20 percent to 30 percent — far lower than the industry average of 52 percent, according to a 2012 report by nursing home industry group the American Health Care Association. Buckland estimated that half of the staff at Woodview had worked there at least a decade, with a number of employees having been at the facility for 30 years.

    Another distinctive feature of the top four dozen facilities: a lower percentage of days paid for by Medicaid, the federal health care assistance program for low-income Americans. Residents with a lower level of days paid for by Medicaid tended to be more physically able and to receive more care than those living in facilities with a higher percentage of days paid for by the program, according to the Center’s analysis. The top-ranked facilities averaged just below half of their days paid for by Medicaid, while the average was about 55 percent for all of the homes analyzed. Bita Kash, professor of Health Policy and Management at Texas A & M University, said Medicaid’s comparatively low reimbursements help explain the difference in care levels.

    The Woodview facility where Buckland works was almost exclusively a private-pay facility.

    Buckland said her staffing commitment would remain constant even if she had a higher percentage of Medicaid residents, but she acknowledged that a higher Medicaid load can impact administrators’ ability to provide the staff  that are needed.

    "I would still maintain the same staffing numbers," she said. "Maybe public funded [facilities] that have a high census of Medicaid, their payment factors are going to be an issue."

    But it’s an issue that can be handled, as Matt Hartley and his staff of dozens at Portland Health and Rehabilitation Center in Oregon have proven.

    The Portland facility had 86 percent of its days paid for by Medicaid, yet it also earned the highest rating and has shown consistent staffing levels. Hartley cited the home's employee ownership, a supportive headquarters office, a robust level of staff appreciation and opportunities for advancement as critical in creating an environment that allows the staff to consistently deliver high-quality care to the diverse group of about 50 residents.  

    "I’ve worked for other nonprofits and other entities," said Hartley, who's been at Portland Health and Rehabilitation for six years and a licensed nursing homes administrator since 1997.  "It's a breath of fresh air to be in a place that has so many things in place to help you stay organized and provide good patient care."

    Hartley previously worked at other nursing homes. He said he's never seen facilities "staff up" for an inspection.

    Charlene Harrington, professor emeritus of nursing at the University of California, San Francisco, struck a more skeptical note.

    She said the results for the more than four dozen highly-rated homes speak highly of their staffing levels and commitments to resident care and staff development, but added that many other nursing homes don’t act in the same manner.

    “I would say that those homes are not trying to game the system; they’re trying to do the right thing to provide the staff and the care,” Harrington said. “Unfortunately, you see a lot of homes that just don’t understand or aren’t willing to invest in the staff. They’re trying to game the system during the two weeks [of the survey] and don’t invest the rest of the year.”

    This story was written with support from the Fund for Investigative Journalism 

    Jeff Kelly Lowensteinhttp://www.publicintegrity.org/authors/jeff-kelly-lowensteinhttp://www.publicintegrity.org/2014/11/12/16260/running-five-star-nursing-home

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    JPay Inc., the biggest provider of money services for prisoners, has eliminated fees for sending money orders to inmates in three states, creating a free deposit option for families of more than 100,000 people incarcerated in Indiana, Ohio and Oklahoma.

    The move comes after a Center for Public Integrity report showed that the families of hundreds of thousands of U.S. inmates had no way to send money to their incarcerated loved ones without incurring high fees. Several of the prison systems that had no free option for money transfers contracted with JPay for their inmates’ financial services.

    JPay is one of the largest prison bankers, companies that provide financial services to inmates and their families, sometimes charging high fees and sharing their profits with the agencies that contract with them. The company handled nearly 7 million transactions last year and expects to transfer more than $1 billion this year.

    JPay and other prison bankers have become central players in a multi-billion dollar economy that shifts the costs of incarceration onto families of prison inmates, according to the Center’s report. Families must send money to help pay for necessities like toilet paper and winter clothes that used to be provided by the government. JPay says it handles money transfers for 1.7 million offenders, or nearly 70 percent of the inmates in U.S. prisons.

    JPay did not respond to several emails and phone calls requesting comment about the decision to eliminate some fees. The company’s founder and CEO Ryan Shapiro earlier said The Center’s questions about money order deposit fees forced him to consider the impact of policies that affect the company’s poorest customers. He said he would seek to convince states to provide families with a free deposit option.

    The change was confirmed by John Witherow, director of Nevada CURE, an inmates’-rights group. Witherow said he received an email announcing the change from JPay’s public relations manager sometime in the past two weeks. A spokesman for the Indiana Department of Corrections also confirmed the change. Spokesmen for the Ohio and Oklahoma departments did not respond to requests for comment.

    The fees families pay to send money to an inmate vary from state to state. Electronic transfers almost always incur a steep fee charged by JPay or another private vendor. Some states let vendors charge a fee to deposit funds sent by mail but most offer money order deposits as a free option. Florida, an outlier, charges its own processing fee for money order deposits.

    Before JPay and its competitors introduced electronic payments in prisons, inmates’ families typically mailed money orders directly to the facility where their relative was locked up. Many say the process was faster and more convenient than going through JPay. JPay grew rapidly in the past 12 years by offering to save states time and money by handling all deposits into inmate accounts. In exchange, the company is allowed to charge families fees as high as 45 percent for electronic transfers.

    In ten states, JPay processed money orders for free, while four states allowed the company to charge fees of $1 to $2 for accepting a money order.

    After last week’s change, Kansas is the only state where JPay still charges a fee to accept money orders. In the email forwarded by Witherow, JPay PR manager Jade Trombetta says the company is in talks with Kansas to eliminate the fee for money order deposits in that state.

    Florida also charges a 50 cent fee for money order deposits, according to the state’s contract with the company. The other remaining states that lack a free option for inmates to receive money are Arizona, Colorado, Kentucky, Mississippi, Utah and Wyoming.

    A JPay information card distributed at Bland Correctional Center in Virginia and other prisons.Daniel Wagnerhttp://www.publicintegrity.org/authors/daniel-wagnerhttp://www.publicintegrity.org/2014/11/12/16255/prison-banker-cuts-fees-after-center-report

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    If you hate political advertisements, some advice: Give Matt Lauer, Robin Roberts and Charlie Rose the boot.

    The nation's marquee network morning shows — "Good Morning America," "Today" and "CBS This Morning" — attracted more U.S. Senate race-focused ads during the 2014 midterm elections than any other television programs, according to a Center for Public Integrityanalysis of data provided by tracking firm Kantar Media/CMAG.

    The weekday version of ABC's "Good Morning America" led all comers, with nearly 30,000 U.S. Senate-focused ads during the 2014 election cycle. "Today" and "CBS This Morning" played host to about 27,000 and 25,000 ads respectively.

    Republican candidates and political parties, super PACs and nonprofit groups supporting their races aired slightly more ads than their Democratic counterparts for each show.

    "The hard truth remains that people wake up in the morning and turn on their televisions — and political groups know this," said Elizabeth Wilner, senior vice president for politics at Kantar Media Intelligence. "Years from now, if television advertising becomes less important to politics, the morning shows will be the last place where you will still find political ads."

    Such an age is hardly imminent. In all, political candidates and groups aired more than 1 million U.S. Senate race-focused TV ads alone ahead of the 2014 midterms, as Republicans this month seized control of Congress' upper chamber.

    Among non-news programming, game shows "Wheel of Fortune" (about 20,000) and "Jeopardy!" (about 18,000) and sitcom "Big Bang Theory" (more than 14,500) attracted the most U.S. Senate-specific ads.

    Other shows that aired at least 11,000 U.S. Senate-focused ads during their time slots include "Live! with Kelly and Michael," "The Tonight Show with Jimmy Fallon," "Dr. Phil," "The Ellen DeGeneres Show," "The Late Show with David Letterman" and "Family Feud."

    That daytime shows are so popular among political advertisers is hardly coincidence: An exit poll by Edison Research indicated that more than one-fifth of Election 2014 voters were of retirement age — 65 years old or older — and more likely to spend their days at home. More than two-fifths of voters were 45 years old to 64 years old.

    Politicos' advertising choices didn't always match up with their ideology.

    Democratic candidates and liberal groups advertised on the "Ellen" show slightly more than Republican candidates and conservative groups, although the latter still purchased more than 5,200 U.S. Senate-focused ads during the program.

    That's notable since DeGeneres, who is openly gay and married to actress Portia de Rossi, has often been the scourge of some conservative activists, including the American Family Association and the late Rev. Jerry Falwell, who once dubbed her "Ellen Degenerate" upon her publicly revealing her sexual orientation.

    More recently, the Republican Party declared in its platform that the "union of one man and one woman must be upheld as the national standard." It's Senate election arm, the National Republicans Senatorial Committee, ran more than 420 ads on "Ellen."

    Sen. Mitch McConnell, R-Ky., meanwhile, who's poised to become Senate majority leader, stronglycriticized federal court rulings legalizing same-sex marriages. His re-election campaign aired more than 200 ads during the "Ellen" show.

    Similarly, supporters of more traditional families are also big fans of "Modern Family" — a gay couple and their child are central characters — at least when political ads are concerned.

    The campaigns of Republican Sen. Pat Roberts (Kansas) and McConnell, as well as those of Sens.-elect Thom Tillis (North Carolina), Tom Cotton (Arkansas), Joni Ernst (Iowa), are among those who bought dozens of ads during "Modern Family" airings.

    The McConnell campaign's hostility toward Hollywood and its liberal denizens also didn't stop it from airing about 150 ads during "Access Hollywood," a nightly tabloid show.

    And although Democrats routinely lambaste Fox News, accusing it of conservative bias, they're not above buying ads on the network, Kantar Media/CMAG data shows.

    Take the Democratic Senatorial Campaign Committee, which during September and October blasted out fundraising appeals to supporters featuring subject lines such as "Fox News PANIC ATTACK," "Fox News EMBARRASSMENT" and "Fox News MELTDOWN."

    The DSCC ran about 50 ads on "Fox News Sunday" alone.

    Shows that attracted significantly more U.S. Senate-focused TV ads from Democratic candidates and their backers included "Judge Judy," "The Dr. Oz Show," "Jimmy Kimmel Live," "The Queen Latifah Show," soap opera "General Hospital" and morning gabfest "The View."

    Republican candidates and their supporters were much more likely than Democrats to buy ad time on "Wheel of Fortune," "Big Bang Theory," "Nightline," "NBC Nightly News with Brian Williams" and the "CBS Evening News with Scott Pelley."

    From left, Carson Daly, Natalie Morales, Savannah Guthrie, Matt Lauer, Al Roker, and Ronan Farrow on  "Today," in New York. NBC's morning television staple was the second most popular show — behind ABC's "Good Morning America" — among political advertisers targeting U.S. Senate races in 2014. Dave Levinthalhttp://www.publicintegrity.org/authors/dave-levinthalhttp://www.publicintegrity.org/2014/11/12/16232/hate-political-ads-skip-morning-shows

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    Nursing home magnate Floyd A. Schlossberg had to be happy with the Department of Housing and Urban Development on March 30, 2012.

    Nursing home residents and the American taxpayer, perhaps, not so much.

    It was on that day that Cambridge Realty Capital gave initial approval to a mortgage application for $12 million for the Alden Alma Nelson Manor nursing home in Rockford, Illinois.

    The Department of Housing and Urban Development (HUD) insured the loan through a little-known federal program started in 1959.

    The single-story facility that sits on a tree-lined street was recently renamed Alden Debes. It is one of dozens of nursing homes the sturdy, bespectacled Schlossberg has come to own since starting out in the industry in the 1970s.

    A refinance, the $12 million loan had an interest rate of just 3.63 percent — close to the average rate for participants in the HUD program and nearly 2 percentage points less than the rate Cambridge had granted Alden Alma Nelson Manor in 2004 for a similar HUD-backed mortgage.

    But a lot had happened at the home in the years between the two loans.

    For one thing, the state fined the facility a total of $145,000 for its role in three residents’ deaths. It is unclear from publicly available records whether those fines were reduced on appeal.

    In addition, Alden Alma Nelson Manor earned the lowest possible overall quality rating— a one star on a five-star scale — from the federal Department of Health and Human Services (HHS) in 2009. The overall quality mark is determined by rankings on health inspections, staffing levels and metrics like the percent of high risk residents with pressure ulcers. A one-star rating, HHS says, indicates that the care provided is “much below average,” in the bottom 20 percent within a particular state. The score for the Rockford home remained unchanged for seven consecutive reporting cycles into 2011, one of relatively few in the country to retain such a low ranking for that long, according to a 2012 analysis by USA Today.

    Nevertheless, Cambridge Realty granted that mortgage refinance.

     And HUD guaranteed it.

    Business as usual

    An unusual situation? Not really. Nursing homes providing poor care routinely have received HUD-insured acquisition, construction, refinancing and improvement loans all over the country. In fact, since 2001 hundreds of the nation's worst-ranked nursing homes have received one, and in many cases two, low-cost, HUD-backed mortgages worth close to $2.5 billion, according to the Center for Public Integrity’s analysis of loan and ratings data.

     Even though HUD restructured the office that runs the program in 2008 to streamline the mortgage application process and requires submission of the latest quality reports in evaluating potential construction and rehabilitation loans, the number and volume of one-star facilities that got HUD insurance rose each year from 2009 to 2012. Almost two decades of stinging government reports about the program — from the Government Accountability Office and HUD’s Office of the Inspector General— don’t seem to have made much difference.

    HUD spokesman Brian Sullivan wrote in an email that the average overall quality rating of newly-insured skilled nursing facilities has improved every year since 2011, and Dr. David Gifford, senior vice president of quality and regulatory affairs at the American Health Care Association, the leading for-profit nursing home advocacy organization, pointed to the higher percentages of all skilled nursing facilities that have earned the top score, a five-star rating, from the federal government from 2009 to 2013. 

    But U.S.Jan Schakowsky, D-Ill., a leading legislator on senior issues, called the findings “outrageous.” And Charlene Harrington, an emeritus nursing professor from the University of California at San Francisco, says that the insurance pattern raises serious questions about the allocation of public resources, communication between agencies and what she called a shocking lack of supervision.

    “There’s no public scrutiny, no oversight, no coordination,” said Harrington, who contracted with HUD to look at market data for the mortgage program for five years last decade. HUD, she said, is an “agency running amok and it’s been that way since it’s started.”

    Beginnings

    Part of the National Housing Act of 1959, the nursing home mortgage program was created because Congress believed that for-profit nursing homes were having trouble securing loans on reasonable terms. 

    In 1964 the program expanded to include nonprofit nursing homes. 

    HUD officials and lenders generally viewed nursing homes as risky ventures prior to 1965, a government report said, but the inception of the Medicaid program that year provided a more reliable income stream for nursing homes.

    Because HUD guarantees the mortgages, the public pays when a nursing home defaults. Costs include the original loan amount, premium payment requirements and recoveries from the sale of notes and properties, according to a 1995 report by the Government Accountability Office. The report said that HUD data showed that losses of about $187 million, adjusted for inflation, had been incurred since the nursing home program’s inception.

    The program insures mortgages for nursing-home acquisition, construction, refinancing, and improvement. HUD has granted mortgage insurance to more than 7,000 nursing facilities since the mortgage program began. As of August 2014 more than 2,000, or about 13 percent, of all nursing homes held HUD-insured mortgages. The mortgages HUD backed had an average interest rate of 4.2 percent and a combined worth of more than $16 billion.

    In 2012 HUD said the mortgage insurance was part of a group of programs that “strengthen communities across the country.”

    “The role of these programs is especially significant in the current economic climate,” HUD said.

    Seeing stars

    Since 2009, 240 facilities in 38 states and Washington, D.C. have received HUD-backed mortgages worth nearly $2 billion the month after receiving a low, one-star rating from the federal government. Ohio had the largest number, 30, of these homes. Illinois, with 20 homes, was second. California was third. With $242 million worth of HUD mortgage insurance, New York had the highest value of mortgage insurance for nursing homes.

    For-profit corporations were overrepresented among the ranks of one-star homes with the low-cost mortgage loans guaranteed by HUD. Corporations owned a little more than half of all nursing homes, but just over two-thirds of poorly-rated HUD-guaranteed mortgage recipients — a trend criticized by Harrington of USCF. “I think [the HUD-guaranteed mortgages] should be restricted to only doing nonprofits,” she said. “There’s certainly no reason the government should be financing for-profit corporations.”

    For dozens of facilities, the poor quality of care was also not limited to a single inspection cycle, either. More than 30 of the one-star mortgage recipients were among the 564, or about 5 percent of facilities USA Today identified in 2012 as having earned the lowest possible rating from Nursing Home Compare, a government website the public can consult to gain information about nursing homes, for seven consecutive ratings cycles.

    The nursing home industry has argued that the federal five-star rating system is inaccurate and excessively punitive, but HUD-guaranteed mortgage recipients also fared poorly on home safety, according to a 2009 GAO report. About two dozen were on a list of 580 nursing homes that the watchdog agency said should get extra regulatory attention.

    Alden Alma Nelson Manor, which also received state fines for incidents of residents’ sexually abusing and beating up other residents, was a one-star home that was also on the GAO list. So, too, was a facility under different ownership, the former Woodstock Residence in suburban McHenry County, Illinois, now known as Crossroads Care Center Woodstock.

    In 2008 the state of Illinois levied nearly $360,000 in fines against the Woodstock facility after learning about the suspicious deaths of six residents. The penalty was the largest of hundreds the state issued during the decade starting in 2004. Marty Himebaugh, a nurse at the facility who allegedly was called “the Angel of Death” by supervisor Penny Whitlock, later faced charges that she deliberately overmedicated residents. Himebaugh pleaded guilty to felony criminal neglect in the ensuing criminal proceedings. 

    Yet in January 2013, even with the low ratings and the case having generated widespread media attention, the facility received a $4.4 million loan backed by HUD at 2.86 percent. Woodstock was also among a group of 70 of the one-star nursing homes that received at least two HUD-backed mortgages since 2001. The value of those mortgages was more than $530 million.

    But care issues with HUD-guaranteed mortgage recipients extended beyond the one-star facilities.

    In 2009 Bennie Saxon, an 84-year-old World War II veteran known by friends and family for his gentle manner and natty dress, fell four stories to his death at the Alden Wentworth Rehabilitation nursing home, a Schlossberg-owned property on Chicago’s South Side.

    Saxon’s death led to black seniors’ protesting residents’ conditions and to state Sen. Jacqueline Collins convening a hearing about nursing home safety.

    On July 7, 2010, another Alden Wentworth resident died after receiving narcotics there for three weeks, contrary to the instructions of the physician who previously treated him, state records said. The state levied a fine of $20,000 on the facility.

    In August 2012 the facility, which had a two-star rating in July, got a $10.6 million HUD-backed loan at just a 2.5 percent rate.

    A third Schlossberg property, Alden Village North, was the focus of a searing series of articles by the Chicago Tribune throughout 2010 chronicling 13 questionable deaths that led to citations from the state over the previous decade. That facility had been granted a $12.96 million HUD guaranteed mortgage in December 2009, and later got a HUD-guaranteed refinance for the same amount in August 2013.

    The Tribune project prompted the state to revoke Alden Village North’s license in 2011, according to state records. But the facility was able to stay open after a judge ruled that the state had botched its chance to close the home, according to the Tribune.

    2011 report by HUD’s inspector general’s office criticized the low priority HUD officials placed on regulatory enforcement. Because the Somerset Place nursing home in Chicago was current on its mortgage, the report said, HUD was not aware of pressing health and safety issues until the state revoked its license.

    That facility, which received a $28.8 million mortgage that HUD guaranteed in June 2003, had a two-star rating throughout 2009.

    “Had staff been aware of the issues identified by CMS [the Centers for Medicare and Medicaid Services], they may have been able to address the issues prior to the property’s failure,” the report said.

    In its response HUD emphasized its immediate and aggressive actions after learning about the regulatory violation, but others were skeptical.

    Years of critiques

    The 2011 report by the HUD inspector general was but the latest in a series going back more than 15 years that questioned the agency’s stewardship of the mortgage insurance program. HUD’s accounting methods, the hundreds of millions of dollars in defaults, a lack of follow-through on suggested improvements and the monitoring of quality of care were all found wanting.

    “We believe it is unlikely that HUD will be able to effectively manage the nursing home and retirement service center programs in the near future,” the GAO wrote in 1995.

    But HUD spokesman Sullivan said the agency’s management of the program has indeed improved. He said a new handbook for the mortgage program that took effect September 1, 2014, was designed specifically in response to the criticisms contained in the 2011 inspector general report.

    Among the changes: considering the quality of care provided at other homes owned by the same owner of the facility seeking a HUD-insured mortgage.

    The new criteria could present a problem for Schlossberg, one of the state’s largest nursing home operators.

    His homes racked up more than four dozen violations and more than $900,000 in fines from the state of Illinois during the years 2004 to 2014 for more than 10 deaths, maggots growing in wounds, and a wait of 29 days to evaluate a pressure sore, state records said. In many cases the fines were reduced on appeal.

    As of August 2014 Schlossberg held 18 active, HUD-backed mortgages worth about $230 million at an average rate of about 3.5 percent. Cambridge Realty provided all but two of the loans.

    The septuagenarian nursing home owner has also been an active political player. Since 1997 Schlossberg has made hundreds of donations worth close to $700,000 to federal and state candidates, officeholders and organizations affiliated with both major parties nationwide, according to the Center’s analysis of donations data.

    Recipients include Schakowsky, D-Ill., former Speaker of the House Dennis Hastert, R-Ill., and Sen. Mike Crapo, R-Idaho, a member of the Senate’s Banking, Housing, and Urban Development Committee, which oversees HUD.

    Schlossberg did not respond to multiple requests for an interview. His lawyer Ariana Fisch did not respond to requests for comment.

    In a 2013 interview with media startup company CEO Intronet, Schlossberg said the Alden chain plans to build small campuses. If the past is a predictor of future behavior, the longtime CEO is likely to apply for additional HUD backing. More than 20 Alden properties received HUD-guaranteed mortgages since 2001, according to HUD records.

    Michael Thamer, a California lawyer who was the lead attorney in a landmark nursing home staffing case against the Skilled Healthcare nursing home chain, said stern measures are necessary to alter owner conduct.

    “If you’re not eligible for HUD funds unless you have a sterling record, that would have a significant impact on behavior,” Thamer said.

    The story was written with support from the Fund for Investigative Journalism.

    Jeff Kelly Lowensteinhttp://www.publicintegrity.org/authors/jeff-kelly-lowensteinhttp://www.publicintegrity.org/2014/11/13/16265/poorly-rated-nursing-homes-got-hud-guaranteed-mortgages-anyway

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    Top officials at the Lockheed Martin Corporation in 2009 sought to extend their lucrative contract work managing Sandia National Laboratories for the Energy Department, and expected that their political connections would help them gain an inside track for a noncompetitive contract renewal. This is, after all, how Washington usually functions.

    But the Energy Department’s top auditor has asserted in a riveting new report that the firm, and top officials that helped it operate the Sandia nuclear weapons labs in Albuquerque, appear to have violated federal laws when they used some of their contract funds to pay for lobbying and other forms of pressure on DOE to obtain the contract renewal.

    The firm argued during the department’s review of its actions that spending federal funds to obtain more federal funds was “allowable” and only was meant to help the department’s leaders make an informed decision, according to the Nov. 12 report by DOE Inspector General Gregory H. Friedman.

    But Friedman called that decision “highly problematic.” He said it was not only a violation of government-wide contracting regulations, but also “impermissible” under the precise wording of Sandia’s longstanding, multi-billion dollar contract with DOE.

    Friedman’s slender six-page summary of his extensive investigation — many details of his work were declared “For Official Use Only” — is noteworthy because it’s an unusual broadside against what many in the Capital say is a common way of doing business: Get one federal grant, and then use the profits to hire lobbyists — including former members of Congress — to meet with federal officials, lawmakers and others who can help orchestrate a new, even richer federal grant.

    It’s Washington’s own version of a perpetual motion machine — one that has created and enshrined countless fortunes in the Capital region. "Not only is it explicitly against the law for contractors to use taxpayer dollars to lobby federal officials, it's galling that in this particular case, the contractor is using taxpayer dollars to try and do an end-around competition," said Lydia Dennett, an investigator at the Project on Government Oversight, a nonprofit group in Washington.  "This instance is hardly the first time appropriated funds have been abused this way."

    Lockheed Martin wound up getting a two-year contract extension worth $7.7 billion in March of this year to manage Sandia, rather than the 12-year extension it had sought. But a Sandia official, whose name was not given in the report, acknowledged in a 2010 email obtained by Friedman that its federally-funded campaign for a Lockheed Martin extension was not new.

    Sandia used “operating costs” — a budget account funded by DOE — “in the same way in securing” contract extensions in 1998 and 2003, and also coordinated its effort closely with Lockheed Martin, Friedman’s report quotes the Sandia official as writing.

    Sandia’s top counsel had specifically warned in 2004 that neither Sandia nor its direct overseers in the Energy Department “could tolerate even the suspicion” that Sandia was using its contract revenues to help Lockheed win a new contract, Friedman wrote. After all, the contract stated that Sandia “shall not have any interface with any present or potential Federal, state, municipal” officials or legislators for the purpose of obtaining or retaining business, his report said. It is, in fact, a standard federal contract rule that recipients of federal funds cannot use those funds “to pay any person for influencing or attempting to influence an officer of any agency or a member of Congress” about an extension.

    Sandia’s officials planned nonetheless to use their political connections to get such an extension, beginning in 2009, Friedman wrote. In an internal document prepared that year, officials candidly vowed to try to persuade DOE that no other firms should be allowed to bid on the work, but said if that effort failed, they would attempt “to influence the evaluation criteria” — in effect, to jigger the competition.

    Sandia also hired three consultants, who urged an extensive lobbying campaign involving the state’s congressional delegation, a former U.S. Senator, a former governor, and a former head of the National Nuclear Security Administration. None are named in Friedman’s summary, but it says that DOE overseers at Sandia concluded the labs engaged a former Republican congresswoman, Heather Wilson, to participate in the taxpayer-funded campaign for a contract extension.

    According to news reports, Sandia’s contract with a firm Wilson created called for payments of $10,000 a month for her strategic advice, but barred her from lobbying. After DOE officials protested the arrangement, Sandia repaid the DOE a total of $226,000 that it paid Wilson.

    Wilson, who worked at the White House under President George H.W. Bush and now directs the South Dakota School of Mines and Technology, said in a prepared statement that she had done nothing wrong. "I was not a lobbyist for Sandia and I did not contact any federal official — Congressional or Executive — for Sandia to try to extend the Sandia contract,” she said. Wilson is presently on a DOE-organized panel meant to advise the department about how the nuclear weapons laboratories should be organized and paid for by DOE.

    According to Sandia documents cited by Friedman, the labs’ message in its lobbying was that allowing competition for a new contract was unnecessary and not in the government’s interest. These points were emphasized in a letter sent by a senior Lockheed executive to then-Secretary of Energy David Chu.

    A Lockheed spokesman, Matthew Kramer, said in a prepared statement that "Sandia Corporation, a wholly-owned subsidiary of Lockheed Martin that operates Sandia National Labs, has cooperated with the Inspector General’s review and will continue to do so. Lockheed Martin will cooperate fully with Sandia and the Department of Energy as needed." Sandia spokeswoman Heather Clark said that while the labs are still reviewing the report, “Sandia takes these allegations seriously and has cooperated fully in the Inspector General's review of the issue … Sandia is confident that the company and the DOE will be able to resolve these issues.”

    Frank Klotz, who became director of the National Nuclear Security Administration this year, affirmed in a written response to the audit that Sandia’s payments to Wilson were “unallowable,” and that officials are now assessing whether other salaries and fees paid to Sandia employees and consultants from DOE revenues should be recovered. He also said that NNSA might adjust its overall payment to Sandia once its probe is complete. “We take this issue seriously, and are committed to … taking preventive measures to ensure this does not recur,” Klotz said.

    Data reporter Alex Cohen contributed to this article.

    This August 1997, file photo, shows the exterior of the Center for National Security and Arms Control at Sandia National Laboratory in Albuquerque, N.M.R. Jeffrey Smithhttp://www.publicintegrity.org/authors/r-jeffrey-smithhttp://www.publicintegrity.org/2014/11/13/16270/nuclear-weapons-lab-used-taxpayer-funds-obtain-more-taxpayer-funds

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    The 2014 election is over in nearly every race and voters can now turn on their televisions without being inundated with political ads. Here’s a tally of how the TV ad wars played out, according to a Center for Public Integrity analysis of preliminary data from media tracking firm Kantar Media/CMAG.

    • The big numbers: More than 1 million TV ads aired for U.S. Senate races, while more than 1.4 million ads ran about state-level races.
       
    • Thirty-six races on two stages: Ads for the 36 governorships at stake cost an estimated $583 million, while ads for the 36 U.S. Senate seats cost an estimated $477 million in airtime.
       
    • Hottest TV ad war: The most expensive race overall was Florida governor’s contest at $98 million, with ads supporting Republican Gov. Rick Scott outnumbering ads supporting Democratic nominee Charlie Crist and his running mate by almost 2-to-1.
       
    • Most negative state:Florida also had the most negative ads in the nation, with more than 96,600 airings of attack ads — more than the total number of political ads that ran in 39 states. North Carolina came in second with more than 89,200 negative ads, mostly in the U.S. Senate race in which Republican Thom Tillis ousted Sen. Kay Hagan, a Democrat.
       
    • Hottest U.S. Senate races: Six U.S. Senate battlegrounds accounted for more than half of all U.S. Senate-focused TV advertising. North Carolina had 114,300 ads, followed by Iowa (where 97,500 ads aired), Kentucky (88,300), Louisiana (78,100), Georgia (75,300) and Colorado (67,400). Republican candidates prevailed in five out of six of these states. The sixth — Louisiana — won’t be decided until a Dec. 6 runoff between Democratic Sen. Mary Landrieu and Republican Rep. Bill Cassidy. Ads continue to run there.
       
    • Bigfoot ballot measures: With an estimated $107.5 million in TV ads, more was spent on the airwaves for California’s six statewide ballot measures than on any single elective office in the country. That was more than half of the $204 million spent buying airtime for the 158 statewide ballot measures nationwide. Another $20.7 million was spent on local measures around the country.
       
    • Most airtime: The candidates whose campaigns bought the most ad spots were: Texas gubernatorial candidate Greg Abbott (45,600 spots), Illinois gubernatorial candidate Bruce Rauner (40,600), Louisiana’s Landrieu (29,200), Illinois Gov. Pat Quinn (27,500) and Senate Minority Leader Mitch McConnell, R-Ky., who aired about 25,600 ads. Only Quinn lost; Landrieu’s race has not been decided.
       
    • Campaigns still dominate: Senate candidates were solely responsible for about 52 percent of all U.S. Senate-focused TV ads, while state-level candidates were responsible for two-thirds of ads. Political parties accounted for less than 14 percent.
       
    • Outsiders chime in: In U.S. Senate races about 37 percent of the ads were sponsored by non-party groups, such as political action committees, trade associations, unions, super PACs and other politically active organizations. On state-level races, such groups bought about 20 percent of the ads, far more than the nearly 13 percent in 2010.
       
    • Secretive groups on the rise: In six of the hottest U.S. Senate races, groups that do not disclose their donors accounted for at least one of every five TV ads. And three of the top five outside groups active in U.S. Senate races fell into that category: Crossroads GPS, a nonprofit co-founded by GOP strategist Karl Rove (which aired 30,900 TV ads in U.S. Senate races); Americans for Prosperity, a nonprofit supported by the conservative billionaires Charles and David Koch (28,300); and the U.S. Chamber of Commerce (17,000).

    Want to know more? Explore our findings with our ad trackers for state-level offices, ballot measures and the U.S. Senate.

    SourceCenter for Public Integrity analysis of preliminary data through Nov. 4 from Kantar Media/CMAG.

     

     

    Florida Gov. Rick Scott stands at the podium before making a victory speech after defeating Democratic challenger, former Republican, Charlie Crist, in Bonita Springs, Fla. on Tuesday, Nov. 4, 2014. Michael Beckelhttp://www.publicintegrity.org/authors/michael-beckelReity O'Brienhttp://www.publicintegrity.org/authors/reity-obrienKytja Weirhttp://www.publicintegrity.org/authors/kytja-weirhttp://www.publicintegrity.org/2014/11/14/16274/nearly-100000-negative-ads-helped-turn-tide-florida-elections

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    Sen. Mary Landrieu's overtime bid to win re-election began with a decidedly sluggish start, as Republican opponent Bill Cassidy and his allies last week pummeled her — effectively uncontested — with hundreds of television advertisements.

    Landrieu's campaign didn't air any TV ads during the four days immediately following Nov. 4's general election, when she earned a plurality of the vote but failed to break 50 percent, which triggered a Dec. 6 runoff with Cassidy.

    Not until Sunday, Nov. 9, did Landrieu's campaign return to TV after a sustained advertising push that abruptly ended on Election Day, according to a Center for Public Integrity analysis of data from Kantar Media/CMAG, an ad tracking service.

    When it did, the campaign aired a modest 70 ads between Sunday and Monday, Kantar Media/CMAG data indicates — although the messages were biting, lampooning Cassidy as an incoherent bumbler unable to string a sentence together.

    Meanwhile, super PACs, political party committees and other organizations that had together run thousands of ads during the general election phase in support of Landrieu were nowhere to be found on Louisiana's airwaves after Election Day. And the Democratic Senatorial Campaign Committee reportedly canceled its scheduled ad buys buoying Landrieu.

    Cassidy's campaign, in contrast, ran nearly 700 TV ads from Nov. 5 through Nov. 8. And the National Republican Senatorial Committee aired about 350 TV ads from Nov. 5 to Nov. 8 blasting Landrieu.

    Meanwhile, Freedom Partners Action Fund, a super PAC backed by the political network of billionaire brothers Charles and David Koch, sponsored another 175 anti-Landrieu TV ads during that timeframe.

    That's a marked change from earlier in the race, when Landrieu ruled the airwaves.

    Landrieu's campaign accounted for nearly two of every five TV ads aired in the race through Nov. 3 — more than any other advertiser in the race. Overall, Landreiu and her allies aired about 70 percent more TV ads than all Republican candidates and conservative groups active in the race ahead of the Nov. 4 election.

    Landrieu's campaign did not respond to requests for comment.

    In a fundraising solicitation to supporters Thursday, Landrieu campaign Finance Director Kate Magsamen struck an upbeat tone.

    "Since we started this all-or-nothing runoff for the last Senate seat in the country, support has been pouring in from all over Louisiana and throughout the country — including $508,150 online alone," Magsamen wrote. "Mary has asked us to reach $600,000 in online contributions by Su‌nda‌y ... we need to seize this opportunity now."

    The campaign is now using its cash in an attempt to keep its recent advertising gap from widening, reserving hundreds of 30-second ad spots on stations throughout Louisiana.

    On WBRZ-TV 2 in Baton Rouge, Louisiana, for example, the Landrieu campaign is dropping more than $22,000 on ads that began Monday and are scheduled to run through Sunday, according to a filing with the station.

    On WWL-TV 4 in New Orleans, the Landrieu campaign reserved about $21,500 worth of ads for the same time period, FCC filings indicate.

    Landrieu has plenty of conservative company, however, with organizations such as pro-Cassidy super PAC Ending Spending Action Fund booking significant TV ad buys for mid-to-late November.

    The Federal Election Commission next requires the Landrieu and Cassidy campaigns to file financial disclosures — they will reveal their fundraising and expenditure numbers through Nov. 16 — on Nov. 24.

    The most recently filed FEC records indicate the Cassidy campaign on Oct. 15 had about $3.1 million cash on hand, while the Landrieu campaign had about $1.64 million.

    The runoff between Landrieu and Cassidy is Dec. 6. Early voting begins Nov. 22.

    Sen. Mary Landrieu, D-La. acknowledges supporters at her election night headquarters in New Orleans, Tuesday, Nov. 4, 2014. Landrieu did not win 50 percent of the general election vote and finds herself in a runoff with Republican U.S. Senate candidate, Rep. Bill Cassidy, R-La. Dave Levinthalhttp://www.publicintegrity.org/authors/dave-levinthalhttp://www.publicintegrity.org/2014/11/14/16273/slow-start-landrieus-runoff-campaign

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    The memory of the suffering Letasha Mims endured at the Alden Wentworth nursing home on Chicago's South Side still makes her mother Mary weep. 

    In less than two years she developed a decubitus ulcer on her buttock.

    She lost close to 60 pounds.

    Her feet developed gangrene and her legs contracted upward toward her torso. 

    A majority-black facility, Alden Wentworth in 2012 listed registered nurse staffing levels on a government website that were among the lowest 17 percent of more than 15,000 skilled nursing facilities nationwide.

    That website, Nursing Home Compare, is promoted by the government and widely used by the public in making nursing home choices. The staffing figures are based on self-reported data for the period two weeks before annual nursing home quality surveys.

    But a Center for Public Integrity investigation has raised questions about the accuracy of the oft-used Nursing Home Compare information. Critics say it may reflect staffing levels that are briefly inflated for the sake of the annual quality survey. The Center’s probe found that hard-to-locate Medicare cost reports filed by nursing homes show lower daily staffing levels, especially among registered nurses, than those reflected in Nursing Home Compare. In 2005 the federal Centers for Medicare and Medicaid Services cited Medicaid cost reports that contain much of the same information as the Medicare documents as being a more accurate source than the data collected by state surveyors for the quality survey.

    Although homes with residents of all racial groups had lower registered nurse staffing levels listed in the cost reports, the discrepancy was particularly pronounced in nursing homes where the majority of residents were either black or Latino. And the overall gap in this type of care for minorities was even more dramatic.

    Hundreds of majority-black homes throughout the country were listed in Nursing Home Compare as providing a little more than a half-hour of registered nurse care per day. But the average daily level of registered nurse care at those facilities calculated through the Medicare cost reports was just about 20 minutes a day. Medicare cost data was not available for Alden Wentworth. The amount of registered nurse care is widely considered an important measure of quality care.

    This staffing gap was even more stark in nursing homes where Latinos composed more than half of the residents.

    “Majority-white” facilities (i.e., where a majority of residents were non-Latino whites) had daily average registered nurse staffing levels that were about 60 percent higher than majority-Latino nursing homes and about 34 percent higher than black facilities, the Center found in its analysis of the Medicare cost reports.

    The disparities for majority-black nursing homes existed nationwide, but were particularly high in several Midwestern states, including Illinois, Michigan and Wisconsin.  Among metropolitan areas with at least five facilities where black people made up the majority of patients, Chicago and Houston had notably low registered nurse staffing levels relative to majority-white homes, the Center found.

    For Latinos, cities in Texas, among them El Paso and Brownsville, had daily registered nurse care levels of about 10 minutes per resident.

    The Center analyzed a series of variables, including how rural or urban the area was where the home was located, the residents’ average physical ability when they entered the nursing home, and the percentage of days paid for by Medicaid, the state-federal health care assistance program.

    But none of these variables accounted for all of the disparities between majority-white homes and majority-minority homes. Residents in black and Latino homes got far less registered nurse care than those in white facilities, even when the residents were equally sick and poor.

    Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color and national origin by health care providers that receive federal dollars from programs like Medicare and Medicaid, said Rachel Seeger, a spokeswoman for the U.S. Department of Health and Human Services’ Office of Civil Rights.

    Seeger said that anti-discrimination laws do cover discrimination in the levels and quality of staffing in federally funded nursing care homes, but added that the office could not say whether the Center’s analysis revealed civil rights violations. The Centers for Medicare and Medicaid Services declined to comment.

    But the findings disturbed Richard Mollot, executive director of New York advocacy group Long Term Care Community Coalition (LTCCC).

    “It is… troubling that these disparities exist even when Medicaid days and needs of residents are factored in,” Mollot wrote in an email. “My feeling has long been that some providers take advantage of situations in which there are lower expectations — such as in poorer and minority communities — to provide lower levels of services.”

    Registered nurse staffing critical 

    Numerous academic studies published since 1990 have shown a connection between registered nurse staffing levels and residents’ quality of care and health outcomes.

    Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, the nation’s largest nursing homes advocacy group, explained that the importance of registered nurses has grown during the past decade as residents have come into nursing homes from hospitals sicker than in previous years due in part to shorter hospital stays.

    The Center analyzed 10 years of health data from Vincent Mor, professor of community health at Brown University, finding that the average sickness levels for residents moving into nursing homes rose 9 percent from 2001 to 2010.

    Registered nurses are the only workers with the credentials, education and training to conduct assessments, Grant said. Not having a nurse in the facility at all times means there is no one there who can evaluate a medical situation and respond.

    “As a result, residents may not be sent to the hospital when it is critically necessary or be sent unnecessarily, leading to devastating and even fatal consequences,” she said.  

    Nearly all of the majority-black and Latino facilities were operated on a for-profit basis and on average had larger patient populations than the majority-white nursing homes. Mor said this is in part a reflection of black and Latino seniors having fewer nursing home options in their neighborhoods than white seniors.  

    “Nursing homes are even more segregated than cities, and cities are very segregated,” said Mor, who has published several articles about the racial distribution of residents in nursing homes. 

    “The best predictor of which nursing home somebody will choose is proximity to their zip code of origin,” Mor said.

    The issue of race compounds the effect of residential segregation, according to Ruqaiijah Yearby, law professor at Case Western Reserve University in Cleveland.

    Charlene Harrington, a retired nursing professor from the University of California San Francisco, said that the absence of any federal regulations establishing minimum staffing levels means that large homes, like those that are often the only choices for residents in black and Latino neighborhoods, are not required to have any more staff than smaller facilities.

    “So large homes have been historically understaffed, and they have consistently had more deficiencies than small homes,” Harrington wrote in an email.

    Registered nurses are also the most expensive workers in nursing homes. As a result, they can be the focus of cost-cutting efforts by for-profit and nonprofit nursing home owners alike, according to Mollot of LTCCC.

    In 2012, registered nurses earned an average of almost $68,000, according to data from the Bureau of Labor Statistics.

    Certified nursing assistants and orderlies earned less than half that amount.

    David Gifford, senior vice president of quality and regulatory affairs at nursing home organization the American Health Care Association, did not address the disparity issue directly, but said improved staffing ratios in nursing homes across the country are one of several factors that are contributing to a “continually improving” quality of care.

    But Mor pointed out that poorer quality nursing homes are in less affluent areas with higher concentrations of minorities and often have trouble attracting skilled staff.

    “They don’t want to go there, and they have alternatives,” Mor said. “They can go to a hospital and make more money.”

    Agonizing choices

    In early 2014 Letasha Mims went to the hospital after her stay at Alden Wentworth.

    Mary Mims said she had tried to move her daughter, but other nursing homes would not take her.  

    The low staffing levels remained the same throughout her daughter’s time at the Alden home, she said.

    Alden Network founder and owner Floyd Schlossberg declined repeated requests for comment.

    In February, Mims uttered words to her youngest daughter that she never imagined she would have to say.

    “I do not want you to suffer,” she said.  “If your desire is to live I’m going to fight for you until the very end, girl. But if your desire is to go, I’m going to get over it.

    “And I’m going to be OK,” the mother said.

    Letasha Mims died in August 2014.

    Mary Mims said she is determined to fight to improve the care other nursing home residents receive.

    Change may come from civil rights groups demanding equal treatment for minority residents, said Dr. Martha Daviglus, professor of medicine at the University of Illinois at Chicago.

    In July 2010 a jury returned a $677 million verdict in a class-action lawsuit against nursing home chain Skilled Healthcare Group Inc. for failing to comply with California’s minimum nurse staffing requirements and misleading its residents and the public about its actual staffing levels. Rather than pursue an appeal, two months later the company settled the case for $62.8 million, including $12.8 million to add staff and comply with a continuing injunction. The firm did not admit to any wrongdoing.

    Yearby of Case Western said she didn’t know of any examples of nursing home class-action suits based on race or ethnicity.

    “This shouldn’t happen,” said Daviglus, principal investigator of a landmark longitudinal study of Latino health. “If we don’t address this, we’ll never be able to narrow the gaps on health disparities.”

    The story was written with support from the Fund for Investigative Journalism.

    Jeff Kelly Lowensteinhttp://www.publicintegrity.org/authors/jeff-kelly-lowensteinhttp://www.publicintegrity.org/2014/11/17/16275/nursing-homes-serving-minorities-offering-less-care-those-housing-whites

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    When I saw the news coverage of White House health care adviser Jonathan Gruber’s remarks, in which he essentially called Americans stupid, I thought of the old saying, “With friends like that, who needs enemies?”

    My next thought was, who’s being stupid here?

    Gruber is an MIT health economist who worked on health care reform with both Mitt Romney, when he was governor of Massachusetts, and the Obama administration. In fact, he’s one of the reasons Obamacare looks so much like Romneycare, which Massachusetts lawmakers enacted in 2006.

    During remarks he made at the Health Economists Conference at the University of Pennsylvania last year, Gruber claimed that the Obama administration and Congressional Democrats had no choice but to keep the public in the dark, and even mislead folks, about certain aspects of the reform bill as it was being written.

    “The lack of transparency is a huge political advantage,” Gruber said. “And basically call it the stupidity of the American voter or whatever but basically that was really, really critical to getting this thing passed … ”

    The White House hired Gruber in 2009 to help figure out the economic consequences of various health care proposals. Considering how inept the Democrats have been from the beginning in explaining how the reform law would benefit all of us — and why it was structured the way it was — I wouldn’t be the least bit surprised if we found out Gruber had also been hired to provide PR advice on how to sell the law to the public.

    The Democrats’ strategy seems to have been to say as little as possible both about why reform was needed and how the final law would protect us from insurance industry abuses. Which, fortunately, it does. The problem is that most Americans have forgotten that it does — if they ever knew about it in the first place.

    The reason I decided to advocate for reform after I quit my industry job in 2008 was because of those abuses. When he was running for president, Obama often cited those abuses, but after he became president, he and those around him seemed to forget the importance of constantly reminding the public why reform was necessary.

    I got so frustrated at what appeared to be the absence of a communications strategy that I even went so far as to call the White House in the summer of 2009 to offer some unsolicited ideas. I was thanked for my interest but essentially told, “don’t worry, we’ve got this figured out.”

    A few weeks later, I thought maybe that was true. In an address to a joint session of Congress on September 9, 2009, Obama did indeed remind the public about why reform was needed. He made a pretty compelling case. Here’s how he laid it out:

    “ … But the problem that plagues the health care system is not just a problem for the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day.

    “What this plan will do is make the insurance you have work better for you,” he said. “Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it the most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime … ”

    He also cited a few other provisions of the plan that would provide Americans with “more security and more stability.”

    I was encouraged because I thought the White House and Congressional reform advocates had once again realized what Americans needed to hear. I thought sure they would develop a communications strategy around those very points.

    I thought wrong. The White House and Congressional Democrats let their opponents define the law. And those opponents did a superb job of developing and implementing a communications strategy to turn the public against what they decided to call “Obamacare.” That campaign has been so successful it has almost completely obscured the fact that the law actually benefits each and every one of us. 

    I can only guess that Obama’s team was persuaded that a lack of transparency, even about the good the law does, would be better than going to the trouble of trying to explain it.

    Now that, in my opinion, is what’s really stupid.  

    Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.

    Jonathan Gruber at a Capitol Hill hearing on the overhaul of the health system in 2009.Wendell Potterhttp://www.publicintegrity.org/authors/wendell-potterhttp://www.publicintegrity.org/2014/11/17/16284/obama-administration-let-opponents-define-affordable-care-act

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    There's no better proof that U.S. elections never end than the fundraising scene this month in Washington, D.C.

    No matter that Election Day 2014 isn't even two weeks past and Election Day 2016 is 721 days away: Lawmakers (and soon-to-be lawmakers) are using Congress' lame duck session to generate cash wherever they can get it.

    Some are bent on retiring debt incurred a historically expensive midterm campaign. Others are spending their time back in the nation's capital filling their coffers for political battles two or more years away.

    Here are 10 politicos already back on the fundraising trail, according to documents obtained by the Center for Public Integrity:

    • Sen. Cory Booker, D-N.J., will hold court Wednesday evening at Rosa Mexicano in D.C.'s Chinatown neighborhood. The minimum donation to attend the cash fiesta is $1,000. Booker easily won re-election this month and isn't up for re-election until 2020. As of Oct. 15, his campaign reported nearly $2.6 million cash on hand.
       
    • For a minimum contribution of $500, on Thursday you may attend a "debt retirement reception" with Sen. Pat Roberts, R-Kansas, who avoided involuntary political retirement after defeating upstart independent challenger Greg Orman on Nov. 4. The reception will be conducted at 220 E St. NE in D.C., according to an invitation. That's notable since the address belongs to lobbying firm R.B. Murphy and Associates, whose clients this year have included tobacco company Altria Group, Google and DirecTV. Roberts' campaign had no debt as of Oct. 15 and more than $927,000 cash on hand, according to disclosures filed with the Federal Election Commission.
       
    • Sen.-elect Ben Sasse, R-Neb., conducted a fundraising breakfast last Friday. "This is to help retire his primary debt ... If you can't help with this one, but want to help Ben with debt retirement please let me know," Sasse fundraiser Jon Graham wrote a prospective donor last week. The Sasse campaign reported $1.64 million cash on hand and more than $516,000 in debt as of Oct. 15, according to disclosures filed with the FEC. Sasse had personally loaned his campaign more $113,000 through mid-October.
       
    • Rep.-elect Bob Dold, R-Ill., this month won back a seat in Congress he lost in 2013. On Wednesday evening, he will host a reception at the City Tap House in D.C. to "celebrate his election and retire his debt," according to an email from fundraiser Katy Cannon to a prospective donor. Cannon also told the prospective donor that Dold is available to meet in more intimate settings. "If you can't make this event, Bob will be in DC until November 20th and would love to get together for a 1-1," Cannon wrote in the email. "Please let me know if you would like to schedule a time. We will also be doing a series of industry meet and greets. Please let me know if you would like to help get your industry together for one." As of Oct. 15, Dold's campaign reported to the FEC more than $1 million in the bank and just $3,000 in debt — for furniture rentals.
       
    • Rep.-elect Ken Buck, R-Colo., is inviting previous campaign donors to a free "thank you reception" Wednesday night at the Capitol Hill Club in D.C. If you've never donated to Buck, you're still invited — for a recommended contribution of $500, or $1,000 if you represent a political action committee. Buck easily won election Nov. 4 and had reported more than $222,000 cash on hand and no debt through Oct. 15.
       
    • Rep. Cedric Richmond, D-La., is also throwing a "thank you reception" on Dec. 10 at Del Frisco's Grille in D.C. While those who contributed during the 2014 election cycle aren't required to again pony up, new supporters don't appear they'll get a free pass — although the invitation itself does not list suggested levels of financial support. Richmond won a third term this month.
       
    • Rep. Ron Barber, D-Ariz., is pleading with D.C. donors for money to fund his vote recount effort following a campaign against Republican Martha McSally that ended with her less than 200 votes up on him. "Congressman Barber is committed to ensuring that every lawful vote is counted and that the voices of Southern Arizona are heard," the "Ron Barber Recount Fund" and the "Arizona Democratic Party Voter Protection Fund" wrote in a joint email that was received by a D.C.-based lobbyist. "As it will be weeks before this process is complete, Congressman Barber's campaign will need additional resources to cover costly legal fees and other recount-related expenses."
       
    • Sen. Bob Casey, D-Pa., doesn't face re-election until 2018. But that's not preventing him from conducting a "holiday lunch" on Dec. 3 in D.C., with entry to the gathering going for $1,000, according to an invitation. Sen.-elect Gary Peters, D-Mich., is listed as a "special guest," although the money raised will go to Casey's campaign. The invitation also notes that Casey's campaign will be conducting a fundraiser in March in Sarasota, Fla., during Pittsburgh Pirates spring training.
       
    • Sonoma restaurant will play host Wednesday afternoon to Rep. Kristi Noem, R-S.D., where a $500 contribution is required to get one through the door. 
       
    • It appears no federal-level candidate was quicker to raise money after Election Day than Sen.-elect Tom Cotton, R-Ark., whose campaign on Nov. 5 sent out an invite for a D.C. fundraiser that took place Thursday. The evening event, held at Capitol Hill restaurant Johnny's Half Shell, required a minimum $500 contribution.
    Dave Levinthalhttp://www.publicintegrity.org/authors/dave-levinthalhttp://www.publicintegrity.org/2014/11/17/16286/congress-never-ending-political-money-chase

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    Americans for Tax Reform, the anti-tax group headed by Grover Norquist, helped bankroll Independent Women’s Voice, a conservative-leaning nonprofit that has pushed to elect Republican political candidates, according to new tax documents reviewed by the Center for Public Integrity.

    In 2013, Americans for Tax Reform contributed $260,000 to Independent Women’s Voice— a grant that accounted for about 13 percent of its $1.98 million in revenue last year.

    Based in Washington, D.C., and led by Heather Higgins, Independent Women’s Voice in recent years has spent hundreds of thousands of dollars backing Republican politicians such as 2012 presidential nominee Mitt Romney, Wisconsin Gov. Scott Walker and Chris McDaniel, who unsuccessfully challenged incumbent Sen. Thad Cochran, R-Miss., in a contentious primary earlier this year.

    In 2013, Independent Women’s Voice spent about $160,000, according to filings with the Federal Election Commission, aiding Republican Mark Sanford, the former governor of South Carolina, during a special election contest in which he ultimately prevailed over Democrat Elizabeth Colbert Busch, the sister of comedian Stephen Colbert. It also wants to see President Barack Obama’s health care reform law repealed.

    That spending was part of an overall surge of political activity last year by Independent Women’s Voice, which says it aims to “engage more women in the political process.”

    The nonprofit told the Internal Revenue Service it spent nearly $960,000 on all “direct and indirect political campaign activities” in 2013 — about 41 percent of the $2.3 million it spent last year — according to a recently filed tax return.

    That’s up significantly from 2012, when it spent about $380,000 on “direct and indirect political campaign activities,” which represented about 7.6 percent of its total expenditures. And it’s also an increase from the last non-election year in 2011, when Independent Women’s Voice spent about $350,000 (or 35 percent of its total expenditures) on such activities.

    Both Americans for Tax Reform and Independent Women’s Voice are organized as “social welfare” nonprofits under Section 501(c)(4) of the U.S. tax code.

    As such, they are not allowed to have a "primary" purpose of engaging in "political activities," and they are generally not required to reveal their donors. Grants they make to other nonprofits, however, must be disclosed.

    In addition to Independent Women’s Voice, Americans for Tax Reform also donated $25,000 to Texans for Fiscal Responsibility in 2013 and $11,400 to the Massachusetts-based Citizens for Limited Taxation, according to a copy of its most recent tax return, which was filed with the IRS Monday.

    In all last year, Americans for Tax Reform raised $4.3 million and spent $4 million. Ahead of the 2014 midterm elections, Americans for Tax Reform itself spent $122,500 on ads backing Senate Minority Leader Mitch McConnell, R-Ky., and Republican U.S. Senate candidate Joni Ernst of Iowa, according to FEC filings.

    Neither officials with Americans for Tax Reform nor Independent Women's Voice immediately responded to requests for comment.

    Anti-tax lobbyist Grover Norquist, seen here in 2010, leads nonprofit group Americans for Tax Reform.Michael Beckelhttp://www.publicintegrity.org/authors/michael-beckelhttp://www.publicintegrity.org/2014/11/18/16290/grover-norquist-nonprofit-funded-pro-republican-women-s-group

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    Revenue at Crossroads GPS, one of the nation’s largest politically active nonprofits, crashed from nearly $180 million in 2012 to about $3.4 million in 2013 — a non-election year, according to new tax filings reviewed by the Center for Public Integrity.

    Crossroads GPS reported spending slightly more than $4 million in 2013.

    The bulk of the money it raised in 2013 – more than $2.6 million – came from 17 contributors giving $5,000 or more, including four who gave $500,000 each, the largest listed amount.

    The rest, $706,605, was attributed to vendor refunds, according to the tax filings. In 2012, the group reported 291 contributions of $5,000 or more and donations of $1 million or more made up 83 percent of its funding. Its largest donation that year was $22.5 million.

    Crossroads GPS told the IRS it spent no money on political activities in 2013, another contrast with 2012, when it reported spending more than $74 million.

    As a “social welfare” nonprofit organized under section 501(c)(4) of the U.S. tax code, Crossroads GPS is not required to disclose the identities of its donors. By law, it may not have a “primary purpose” of engaging in political activity.

    The group is among the most prominent nonprofits to face scrutiny by federal regulators over its political activity in the wake of the Supreme Court’s 2010 decision in Citizens United v. Federal Election Commission. It is also a frequent target of campaign finance reformers who argue it should register as a political committee and reveal its donors.

    Crossroads GPS, co-founded by Republican political operative Karl Rove and strategist Ed Gillespie, has maintained it adheres to federal laws governing nonprofits.

    It reported making a single grant in 2013 to an outside organization — $7,612 to the Conservative Policy Project, another group organized as a social welfare organization. The purpose of the grant is described as “social welfare.”

    Paul Lindsay, a spokesman for Crossroads GPS, said the group was newly established at the time and “received a grant from us for administration expenses. The organization has since been terminated.” 

    Its largest grant in 2012, $26.4 million, went to Americans for Tax Reform, an anti-tax group run by Grover Norquist that in 2013 made a large contribution to a nonprofit group that advocates for Republican candidates.

    Crossroads GPS and its sister super PAC, American Crossroads, reported spending a combined $176.4 million on the 2012 elections, according to the Center for Responsive Politics. Roughly $70 million of that was spent by Crossroads GPS. The groups’ money was spent in support of Republican candidates.

    Crossroads GPS ended 2013 with $2.23 million in assets, according to its tax return.

    During the 2014 election cycle, the Crossroads groups spent a combined $47.7 million on federal elections, with about $26 million of that coming from Crossroads GPS.

    Crossroads GPS sponsored more U.S. Senate-focused television ads this election cycle — more than 30,000— than any other single organization that primarily supported Republicans. It ranked second overall to Democrat-backing super PAC Senate Majority PAC.

    Such spending by Crossroads GPS is an indication that the organization was able to raise tens of millions of dollars during 2014 — although firm numbers won't likely be known for another year, when the group files its next tax return. The Wall Street Journal in October quoted Lindsay as saying the group had raised $75 million.

    GOP strategists Karl Rove and Ed Gillespie, co-founders of super PAC American Crossroads and nonprofit group Crossroads GPS.Carrie Levinehttp://www.publicintegrity.org/authors/carrie-levinehttp://www.publicintegrity.org/2014/11/18/16291/crossroads-gps-cash-plummeted-2013

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    “The official did not return request for comment.”

    “The agency declined to comment for this story.”

    “They did not respond to several emails and phone calls requesting comment.

    No matter the wording, each of these statements means the same thing: we don't want to publicly answer questions.

    Lately — whether it’s an investigative, nonprofit newsroom like us, an international outlet like the New York Times, or newer media like Politico or BuzzFeed — when journalists call, officials are choosing to comment less for stories on the record.

    Media Relations Specialist William Gray and Engagement Editor Sarah Whitmire wanted to shine a light on just how often this happens and decided a new blog was the perfect platform.

    Welcome to Couldn’t be reached.

    It will focus on the institutions and people in power — both private and public — who refuse to comment on the record on stories in the public interest. It will be nonpartisan and apply the same high standards to its postings at the Center applies to its investigative reporting.

    On Twitter, we’re launching with our own handle @DidNotComment and using the hashtag #nocommentclub.

    For newsrooms and journalists, that will be the best way to share your story. You’re already tweeting about what you’re writing and producing; send us one, too.  

    For readers, you can tweet us or submit directly on the blog.

    We welcome your comments and submissions.

    couldntbereached.tumblr.comWilliam Grayhttp://www.publicintegrity.org/authors/william-graySarah Whitmirehttp://www.publicintegrity.org/authors/sarah-whitmirehttp://www.publicintegrity.org/2014/11/20/16292/couldnt-be-reached-blog-all-times-officials-refuse-comment

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    In June, Burkina Faso’s minister of human rights and civil promotion, in the midst of civil unrest in her West African nation, traveled to Washington, D.C., to meet with members of Congress and other U.S. officials.

    Helping arrange the meetings: CD Global Strategies, a D.C.-based public relations firm led by Calvin Dark, who touts his experience working on behalf of foreign political officials.    

    The outreach on behalf of Burkina Faso fell squarely under the Foreign Agents Registration Act, an anti-propaganda law meant to make sure the public is informed about any foreign attempts to influence U.S. public opinion and policy.

    The law explicitly requires those acting on behalf of foreign principals to register and disclose their activities to the U.S. Department of Justice within 10 days of agreeing to become a foreign agent and before doing any work.

    But CD Global Strategies didn’t register until Nov. 11, months after its public relations work for Burkina Faso Minister Julie Prudence Nigna/Somda began, a review of FARA filings by the Center for Public Integrity found.

    The disclosures came months after the firm had arranged meetings on Burkina Faso’s behalf with Rep. Karen Bass, D-Calif., ranking member of the House Foreign Affairs Committee’s Subcommittee on Africa, Global Health, Global Human Rights and International Organizations; Sen. Bob Corker, R-Tenn., ranking member of the Senate Foreign Relations Committee; Rep. Hal Rogers, R-Ky., chairman of the House Appropriations Committee; and Sen. Jeff Flake, R-Ariz., a member of Senate Foreign Relations.

    Burkina Faso officials also met with representatives from USAID and the Millennium Challenge Corporation to discuss the nation's human rights efforts. Both entities fund programs in Burkina Faso.

    Ouagadougou, the capital of Burkina Faso, is home to a strategically important base for Pentagon surveillance missions. The country, long viewed as stable, has recently been home to upheaval. In October, demonstrators — some violent— forced the longtime president to flee the country, leaving it under military rule. A transitional government took power Tuesday.

    CD Global Strategies also on Nov. 11 first disclosed work for the West African nation of Togo under an agreement dated Sept. 19, nearly two months earlier.

    CD Global Strategies reported earning $30,000 for the Burkina Faso work and $100,000 for assisting Togo.

    Asked about the belated filings, Dark said, “Everything is fine from our end with the Justice Department. We went through our counsel and filed it and provided all the necessary documents and information.”

    Dark said the firm’s work with Burkina Faso has ended, but the relationship with Togo is ongoing.

    The embassy of Burkina Faso did not respond to a request for comment regarding the filings. A representative from the embassy of Togo said the embassy had no immediate comment and referred questions back to CD Global Strategies.

    In an emailed statement, Marc Raimondi, a spokesman for the Department of Justice, said the agency has a long-standing policy “to decline comment on registrations other than to provide what is currently available on the FARA public website,” but that generally speaking, “the FARA Unit works to ensure registrants meet their obligations to register under FARA. We review all registrations we receive and if there is something that warrants action, the FARA unit takes appropriate action.”

    Burkina Faso Minister Julie Prudence Nigna/SomdaCarrie Levinehttp://www.publicintegrity.org/authors/carrie-levinehttp://www.publicintegrity.org/2014/11/20/16294/pr-firm-busts-disclosure-deadline-while-representing-burkina-faso

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    As she mulls over whether President Barack Obama’s immigration plan could possibly help her, U.S. citizen Nicole Salgado cannot help but feel intense frustration. 

    She is exasperated with repeatedly explaining to members of Congress that it was Congress that approved a 1996 law making it impossible for her to legalize her undocumented husband of 10 years — even though she’s an American citizen who grew up near Syracuse, New York.

    Salgado is also fed up with explaining why she, not by choice, was forced to move to Mexico eight years ago to live with her spouse Margarito Resendiz, a construction worker she met in San Mateo County, California. 

    He was forced to leave the U.S. and serve out a mandatory 10-year minimum “bar” on living in the U.S. That’s a punishment he faced after the couple tried to do the “right thing” and come forward to seek legal status for Resendiz based on his marriage to Salgado.

    The move to Mexico has exhausted the couple’s savings and derailed dreams. And it’s left them struggling to eke out enough of a living in Mexico to raise the couple’s now 4-year-old daughter, who is also a U.S. citizen. At 36, Salgado has patched together gigs teaching English. But she's been unable to make consistent use of her Cornell University education and her master's degree in teaching science from California's San Jose State University. 

    “Living down here in exile,” she said, “I have lost a lot of faith in our U.S. system.”

    Salgado is one of hundreds of thousands of Americans married to undocumented people who have moved abroad to stay with their spouses, suffered through separation from them, or live in constant fear that their spouses will be discovered and deported. 

    These families are wondering if they’ll benefit from Obama’s executive action to temporarily legalize illegal immigrants with close ties to Americans.

    Obama is expected to announce plans in broad strokes on Thursday night in a speech. The expectation is that he will spare certain illegal immigrants with U.S.-born children or U.S. spouses from deportation, as media have reported.

    But the fine details of the plan will be of utmost importance, especially to people like Salgado, whose husband is already outside the country after voluntarily leaving to serve his bar. He cannot get a visa to return unless reforms to the law are made or Obama uses his power to provide a humanitarian path for his return.

    Other foreign spouses have been deported after their marriages, and now have records that could also complicate their return. 

    As the Center for Public Integrity and KQED Radio reported in 2012, some of these couples were torn apart after they discovered that Congress had created obscure but harsh penalties specifically to punish undocumented people who seek green cards after marriage — no matter if those marriages are legitimate and couples already have children together.

    Couples have been shocked to discover that the undocumented spouse must first comply with a minimum 10-year bar before trying to get permanent residency, or a “green card.” Some foreign spouses have been slapped with 20-year bars or lifetime bars if they have a deportation in their history or were accused of falsely claiming to be a legal resident at some point.

    In Resendiz’s case, because he had a prior deportation before marrying, he faced a permanent bar with an option to request a pardon — no guarantees — after 10 years. The application alone for the pardon will likely cost a total of at least $10,000 between filing fees and lawyer’s costs. That’s $10,000 that Salgado doesn’t have now and doesn’t think she will have in the near future. 

    In August, Salgado posted a letter she sent to Obama imploring him to be sure to take into consideration the plight of American citizens like her if he presses forward with executive action. 

    Salgado expressed concern about a backlash from Congress in reaction to any executive action. But she said she and other Americans are suffering from separation or exile — or the anxiety of their spouses being deported— and they need relief from the stalemate over immigration reform in Washington.

    “Be as creative as possible,” Salgado wrote to Obama, “and use the full extent of your powers to take the lead in finding a way to include my family — my husband — and hundreds of thousands of our American families in that vision, and in any executive action you take on immigration, so we do not have to make the decision between family and country anymore.”

    Salgado co-wrote a book about her experiences called Amor and Exile and launched a campaign to deliver it to members of Congress in 2013. She also belongs to a network called American Families United, which has been lobbying Congress and attempting to push forward bills to modify a complex web of penalties and give immigration officials more latitude to exempt couples.

    In the Center and KQED’s investigation, “Separated by Law,” Americans told stories of their family life shattered and their lives impoverished by penalties that were suggested to Congress as a way to deter illegal immigration through example. There is no evidence that the penalties have had any impact on dissuading people from illegal immigration.

    As the Center reported, Los Angeles resident Chris Xitco thought he could still legalize his wife simply just taking her down to a federal immigration center and signing her up and paying a fine. To his dismay, she was given a 10-year bar during an interview that had be conducted in Juarez, Mexico, at a U.S. consulate. The couple had received no prior warning this could happen and they had a new baby. Xitco’s wife, Delia, is still living south of Tijuana, Mexico, in a gated house where Xitco fears for the family's safety and visits on weekends.

    San Diego resident T.J. Barbour, a software engineer, found out about the bars after he married and decided against filing for his wife Mayte’s green card. But she ended up stopped by a police officer for driving too slowly and was held in detention for six months while the couple tried to obtain asylum for Mayte. Immigration agents dumped Mayte in Tijuana after she lost her case without even a warning phone call to Barbour. The couple’s son was 9 at the time and has suffered losing his mother’s care.

    North Carolina native Anita Mann moved to a remote area of Mexico with three small children so they could join her husband, who is still under a 10-year bar. Others who moved to Mexico, including Margo Bruemmer of New Jersey, told the Center and members of Congress about threats they and their children faced in some rural areas where they were living, including extortion and kidnapping.They implored members of Congress to reform laws to allow them to bring their spouses back.

    In February 2013, during a visit to Congress, Bruemmer spoke at a press conference, saying: “I am begging for our lawmakers, in this upcoming immigration reform debate, to not forget those of us already living outside the country, already barred. Please, do not forget us.”

    A Philadelphia member of American Families United, who is married with three children, said she’s worried about being left out if the Obama action does not include her husband. If she tried to legalize him, she said, the 1996 congressional mandates would require he receive a lifetime bar because he was accused of attempting to use a fake ID card years ago.

    Every day, the woman, who asked for anonymity said, she worries that her husband could be detected and deported.

    The professional woman said she hopes undocumented friends she has come know who have U.S. citizen children will benefit from the executive action. But she can’t bear the thought of her husband being left out of any relief because of his history long ago. “As a citizen, it’s like a twilight zone. I don’t even have words to express it,” she said.

    In March 2013, Obama took a measured step for these couples by making it easier for some to apply to receive a special hardship waiver allowing the foreign spouse to return. Congress’ 1996 law does allow U.S. citizens to request such a waiver if citizens can prove they have a devastating medical condition or hardship beyond the normal suffering a spouse might experience due to separation from a mate.

    Obama’s 2013 change allows couples to file for the hardship waiver before the foreign spouse leaves the country to begin serving out a bar. But the option is off limits to people who have deportations in their past or records like the Philadelphia woman’s husband. 

    Kim Anderson, president of American Families United, said her group has tried to press the White House recently to provide measures that would help their members, such as “humanitarian parole,” which could allow citizens to bring back spouses even if only on a provisional basis. The group continues to hope Congress will amend the penalties it created in 1996.

    “I’ve been astounded over the years at the assumptions that you marry a U.S. citizen and get a green card. It couldn’t be further from the truth,” said Anderson, whose own marriage was crushed by the despair over separation. “You should not have to be forced between your life and your country.”

    American Nicole Salgado of New York state, right, was forced to move to Mexico eight years ago because her husband, Margarito Resendiz, left, is required by a 1996 U.S. law to live outside the United States for at least 10 years before his wife can sponsor him for U.S. legal status. Other Americans forced abroad with spouses say they've been thrown into poverty and other hardship and hope President Obama's executive action will let them return. Salgado and Resendiz have a toddler daughter who is also an American citizen.Susan Ferrisshttp://www.publicintegrity.org/authors/susan-ferrisshttp://www.publicintegrity.org/2014/11/20/16298/us-spouses-ousted-immigrants-await-obama-plan

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    As the Internal Revenue Service contemplates new rules to illuminate “dark money” in politics, a little-known nonprofit group is fighting back using money traceable to billionaire brothers Charles and David Koch, drug makers and the cable television industry.

    The group, American Commitment, received 87 percent of its $13 million in funding between 2011 and 2013 from three Koch-connected nonprofits: the Freedom Partners Chamber of Commerce, the Center to Protect Patient Rights and Free Enterprise America, according to tax filings reviewed by the Center for Public Integrity.

    The Freedom Partners Chamber of Commerce — which has been called“the Koch brothers’ secret bank” by Politicohas given $6.4 million to American Commitment, including $140,000 in 2013, according to tax records.

    The Center to Protect Patient Rights — headed by Koch-connected political consultant Sean Noble— contributed about $4.8 million to American Commitment in 2012.

    And another Koch network group headed by Noble, Free Enterprise America, contributed $103,000 to American Commitment in 2011 — nearly half of the $216,500 American Commitment reported raising that year.

    Meanwhile, additional tax records show two major trade associations are also among American Commitment’s donors: the Pharmaceutical Research and Manufacturers of America and the National Cable and Telecommunications Association, both of which share policy positions with American Commitment.

    In 2013, PhRMA contributed $50,000 to American Commitment. That’s up from the $25,000 the drug lobby group gave in 2012. And the National Cable and Telecommunications Association has contributed $20,000 to American Commitment — $10,000 in both 2012 and 2013.

    As a “social welfare” nonprofit organized under Sec. 501(c)(4) of the tax code, American Commitment is not required to publicly disclose its donors, even though it overtly supports political candidates.

    But separate IRS filings show the bulk of American Commitment’s money has come from these nonprofits, which are legally required to disclose grants they provide to other nonprofit organizations.

    American Commitment itself disclosed, as required by law, that in 2013, it received between $100,000 and $150,000 each from four unnamed donors.

    Together, those four donors — one of which appears to have been the Freedom Partners Chamber of Commerce — accounted for half of American Commitment’s $1 million in income last year, according to records filed with the IRS earlier this week.

    Led by Phil Kerpen — a veteran of Americans for Prosperity, the Club for Growth and the Cato Institute — American Commitment has vigorously opposed efforts to force donor disclosure on social welfare nonprofit groups.

    It has derided liberal politicians for what it calls“shameful efforts to amend the Constitution to empower politicians to regulate political speech” and “backdoor regulatory efforts to limit the First Amendment at federal agencies.”

    Earlier this year, after the IRS unveiled a proposal to regulate politically active nonprofits organized under Sec. 501(c)(4) of the tax code, American Commitment co-wrote a letter to the agency’s commissioner calling for the new rules to be “withdrawn and abandoned."

    According to its website, it’s also helped thousands of people flood the inboxes of their lawmakers with the message: “Don't let the IRS gut the First Amendment!”

    Given its involvement in elections, American Commitment ranks high among social welfare nonprofits that would be affected by any new IRS rules governing so-called dark money — cash from publicly undisclosed donors used to boost or bash political candidates.

    Ahead of the 2014 midterms, American Commitment promoted Republican U.S. Senate candidate Thom Tillis of North Carolina in radio ads. In 2013, it backed Republican U.S. Senate candidate Steve Lonegan in his race against Democrat Cory Booker. And Sen. Jeff Flake, R-Ariz., was among politicians American Commitment supported in 2012.

    Campaign finance reform activists for years have called upon the tax agency to take a more aggressive stance regarding politically active nonprofits, which gained the ability to fund advertisements explicitly calling for the election or defeat of lawmakers in the wake of the U.S. Supreme Court’s Citizens United v. Federal Election Commission decision in 2010.

    Groups such as Crossroads GPS on the right, which was co-founded by GOP strategist Karl Rove, and Patriot Majority USA on the left, which is run by allies of Senate Majority Leader Harry Reid, D-Nev., have proliferated — all while legally keeping their donors’ names secret.

    The IRS — which, earlier this year, postponed a public hearing on its highly contentious plan — has vowed to issue a new draft of proposed regulations for social welfare nonprofits in early 2015.

    Industry lobbying groups such as PhRMA and the National Cable and Telecommunications Association have also found an ally in American Commitment.

    One of the National Cable and Telecommunications Association’s top issues: opposing “net neutrality” policies that would regulate the Internet like a utility — a move the trade group says would be “disastrous.”

    American Commitment’s Kerpen, meanwhile, has argued that “regulating and taxing the Internet is obviously a terrible idea.”

    Joy Sims, a National Cable and Telecommunications Association spokeswoman, declined to comment about the group’s donation to American Commitment.

    American Commitment further describes itself as “committed to fully repealing” President Barack Obama’s health care law and replacing it in a way that “empowers patients and doctors” and unleashes “American ingenuity and creativity to cure diseases.”

    Robert Zirkelbach, a spokesman for PhRMA — which supported the passage of Obama’s Affordable Care Act but has also funneled money to groups like American Commitment that want it scrapped — said the trade group often gives out money to “organizations that share PhRMA’s goals of improving the quality of patients’ lives” and “supporting the discovery of new treatments and cures.”

    Other donors to American Commitment remain unknown — exactly how the group wants them to be.

    "We agree with the Warren Court's landmark 1958 ruling in NAACP v. Alabama that protecting the privacy of our members is critical to their core First Amendment rights of free speech and free association,” Kerpen wrote in an email to the Center for Public Integrity.

    (Update, 7:02 p.m., Nov. 20, 2014: This story has been updated to include Kerpen's reference to the NAACP v. Alabamacase.)

    In recent years, the American Future Fund has spent tens of millions of dollars advocating against federal lawmakers, including about $81,000 in late 2013 against Rep. Collin Peterson, the ranking Democratic member of the House Agriculture Committee.

    Like American Commitment, it has done so without disclosing its funders.

    Image from a Facebook campaign by American Commitment that criticized former IRS official Lois Lerner.Michael Beckelhttp://www.publicintegrity.org/authors/michael-beckelhttp://www.publicintegrity.org/2014/11/20/16305/koch-linked-organization-uses-dark-money-fight-political-disclosure

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    Starting in late 2009, the Center for Public Integrity published an investigative series of pieces on how sexual assault complaints are handled on college campuses. After nine months of reporting, the Center reached some troubling conclusions about how certain institutions collect and report sexual assault statistics, and how sexual assault cases are adjudicated in campus judicial systems. Since then, attention to the issue has only intensified.

    This toolkit that accompanied the initial series served as an introductory guide on how to investigate the ways your school deals with sexual assault allegations. A few of the links may be outdated, but the Center attempted to find new ones where possible. 

    Getting Started

    A Few First Steps as You Begin Your Reporting:

    • Look for the school’s annual campus security report on the university website or request a print copy from the university.
    • The U.S. Department of Education also maintains a database of Clery Act statistics provided by schools: http://ope.ed.gov/security/
      • Compare sexual assault numbers provided to the U.S. Department of Education against the numbers published in the school’s annual security report. Sometimes the numbers are different and those differences are red flags for Clery Act violations.
    • Collect numbers for sexual assaults from on-campus and off-campus rape crisis centers and/or student counseling centers for the last three years.
      • Compare those numbers to Clery Act statistics submitted to the Education Department, as well as those published in the annual campus security report.
    • Find out how Clery Act crime data is collected around campus.
      • Compare the school’s collection process against what it is required under the Clery Act.
    • File a Freedom of Information Act request with the U.S. Department of Education to see if the school has ever been the subject of a Clery Act complaint.
      • If there is a complaint, who originated the complaint and why?
      • What was the Department’s response to the Clery Act complaint? Findings? Conclusions?

    The Law

    The Family Education Rights and Privacy Act (FERPA)

    • Passed in November, 1974, FERPA is a federal law that protects the privacy of student education records. It applies to all schools receiving federal funds.
    • The law grants three basic rights to parents of minor-aged students and students aged 18 and older:
      1. the right to access educational records;
      2. to challenge the records’ contents;
      3. to have control over disclosure of “personally identifiable information” in the records.
    • Since Congress never defined what constitutes an education record, some schools have applied FERPA’s provisions to cover pretty much any document that names a student.
    • Some college administrators argue that FERPA requires closed disciplinary proceedings in a variety of matters, including allegations of sexual assault. In promulgating regulations, the Education Department has stated that “FERPA does not [per se] prevent an institution from opening disciplinary proceedings to the public,” but confusion remains over how institutions of higher learning should apply FERPA’s provisions.

    More info: www.ed.gov/policy/gen/guid/fpco/ferpa/index.html

    The Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act)

    More info: “The Handbook for Campus Crime Reporting

    • The Clery Act, passed in November 1990, requires that higher education institutions whose students receive federal financial aid collect and report crime data to the U.S. Department of Education.
    • A 1992 amendment to the Clery Act established the Campus Sexual Assault Victims’ Bill of Rights, requiring schools to provide certain basic rights to survivors of sexual assaults on campus, including:
      1. Giving the alleged victim and the alleged assailant equal opportunity to have others present in disciplinary proceedings and equal notification of the outcome of such proceedings;
      2. Notifying alleged victims of the availability of counseling services, and of their right to pursue remedies through local police;
      3. Notifying alleged victims that they have the option of changing classes and dormitory assignments in order to avoid their alleged assailants.

    Title IX of the Education Amendments of 1972 (Title IX)

    • Title IX is a civil rights law that prohibits sex-based discrimination in educational programs or activities at institutions that receive federal funding.
    • Under Title IX, discrimination on the basis of sex can also encompass sexual harassment, sexual assault, and rape.
    • If a college or university is aware of but ignores sexual harassment or assault in its programs or activities, it may be held liable under the law. A school can be held responsible in court whether the harassment is committed by faculty or staff, or by another student.
    • The Education Department’s 2001 guidance mandates that schools take “prompt and effective action to end [serious] harassment and prevent its occurrence.”

    • More info: www.ed.gov/about/offices/list/ocr/docs/interath.html

    Digging Deeper 

    Clery Act Basics

    To Comply with the Clery Act, Schools Are Required To:

    • Publish and distribute a security report annually by October 1st that includes crime statistics for the past three years and summaries of campus security policies,
    • Provide timely warnings to the campus community on crimes that pose a serious or continuing threat,
    • Keep a public daily crime log, if the institution maintains a campus police or security department.

    Campus Security Authority:

    • The Clery Act defines a Campus Security Authority (CSA) as including any person or body with significant responsibility for student and campus activities, as well as campus police and security staff.
    • CSAs are required to report allegations of crime to campus or local police even if the victim chooses not to file a report with law enforcement or press charges.
    • The Clery Act exempts pastoral and professional counselors from acting as a CSA.

    Examples of Clery Act Violations:

    • Misclassifying crimes. For example, not properly differentiating between forcible rape and non-forcible rape as defined by the Clery Act;
    • Changing crime statistics reported from one annual campus security report to a subsequent campus security report, in regard to the same year;
    • Failure to collect crime reports from a Campus Security Authority such as a dean, athletic coach, or residence hall adviser.

    Filing a Freedom of Information Act Request (FOIA):

    • FOIA allows requests for public records, which may not otherwise be readily available. Some institutions are hesitant to offer easy access to records that are, in theory, public.
    • A FOIA request to the U.S. Department of Education might be needed to obtain records of Clery Act complaints filed against a school.
    • A FOIA request would also come in handy to gain access to records of Clery Act investigations conducted by the U.S. Department of Education.
    • Check out the open-records letter generator on the Student Press Law Center website for help on filing a FOIA request: www.splc.org/foiletter.asp

    Who to Talk To:

    • The campus police department and the local police department, and the campus official in charge of putting together the annual campus security report.
    • Campus Security Authorities such as a dean, athletic coach, or student activities coordinator.
    • Advocates for sexual assault victims at on-campus health clinics and student counseling centers, nearby rape crisis centers, or an on-campus women’s center.

    Identifying Sexual Assault Victims to Talk To:

    • Victim advocates might be willing to introduce you to alleged sexual assault victims.
    • You could also consider sending an e-mail query on a widely read campus listserv explaining that you are looking to talk with students who’ve gone through sexual assault proceedings on campus.

    FERPA — A Potential Roadblock:

    • Schools often incorrectly cite FERPA as a way to block access to judicial records on sexual assault cases involving a “responsible” finding.
    • A campus official might refuse to turn over records on a sexual assault case by arguing that a student’s identity must be protected. However, as long as the records do not identify a student the school should not use FERPA as a valid reason for turning down your records request.

    Investigating Complaints

    • Under Title IX, sex-based discrimination can include sexual harassment, rape, and sexual assault.
    • The U.S. Department of Education’s Office of Civil Rights (OCR) monitors Title IX compliance: www.ed.gov/about/offices/list/ocr/index.html

    Find Out if a Title IX Complaint has Been Filed Against Any School in Your State:

    • For a fee, you could search court records online via PACER, the federal court system’s website: www.pacer.psc.uscourts.gov
    • You might also try searching for case information through your state court system’s website. This is usually free.
      • Key search terms: “Title IX,” “sexual assault,” “sexual harassment,” “rape,” and the name of your school.
    • File a FOIA request with OCR asking for any and all Title IX complaints involving schools in your state over a certain period of time.
    • One way to approach victims who have filed a Title IX complaint with OCR or a Title IX lawsuit is to contact the attorneys who have represented them in their cases. Victim advocates are also a good source to identify students who have filed Title IX complaints with OCR.

    Resources

    Kristen Lombardihttp://www.publicintegrity.org/authors/kristen-lombardihttp://www.publicintegrity.org/2014/11/21/9048/reporters-toolkit-investigating-sexual-assault-your-campus

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    American companies are supplying technology that the governments of Kazakhstan and Uzbekistan are using to spy on their citizens’ communications and clamp down on dissent, according to a new report from the U.K.-based advocacy group Privacy International.

    Verint Systems, a manufacturer of surveillance systems headquartered in Melville, N.Y., has sold software and hardware to Kazakhstan and Uzbekistan that is capable of mass interception of telephone, mobile, and Internet networks, the group alleged in its Nov. 20 report. It also provided the training and technical support needed to run them, the report said. 

    Verint, which claims customers in 180 nations, in turn sought decryption technology made by a firm in California, Netronome, as it helped the Uzbek government attempt to crack the encryption used by Gmail, Facebook, and other popular sites, according to the report. 

    The report’s overall message is that countries in Central Asia — including also Turkmenistan and Kyrgyzstan — regarded as among the world’s most autocratic are getting Western help to install, on a much smaller scale, some of the same advanced mass interception techniques that Edward Snowden revealed are used by the National Security Agency. 

    Those acquisitions have been facilitated in part by loose export controls over surveillance technology. To be subject to U.S. export restrictions, products must appear on a Commerce Department control list — and the key components of the surveillance products described in the Privacy International report do not appear to be on those lists, according to report co-author Edin Omanovic. 

    Products that can lay the foundation for mass surveillance are not restricted by special export controls if they are sold in an off-the-shelf, unaltered state, according to Eva Galperin, a global policy analyst at the Electronic Frontier Foundation, a non-profit digital rights foundation.

    While many of the group’s sources are not listed in the report, and its claims therefore cannot all be confirmed, the report says that staff members interviewed activists in the region who recounted that transcripts of their private communications were used to convict and imprison them on charges of conspiracy. 

    Recent U.S. State Department reports for Kazakhstan and Uzbekistan describe a pattern of state-sponsored torture, inhumane treatment of prisoners, arbitrary arrest, and limited civil liberties in both countries. The State Department’s report on Uzbekistan specifically accused authorities there of detaining and prosecuting activists and journalists for politically motivated reasons. In the Kazakhstan report, “severe limits on citizens’ rights to change their government” was listed as a significant human rights problem. 

    Kathleen Sowers, an assistant to the general manager of Verint Systems, said in a telephone conversation on Nov. 20 that all of the company’s senior personnel were traveling and could not be reached for comment. Netronome spokeswoman Jennifer Mendola said in an email that the company had “no information on the matter” described in the Privacy International report. The company complies with all applicable laws of the United States and every other jurisdiction in which it operates, and “does not condone any violation of human rights or personal privacy,” she added. 

    Privacy International, a 24-year-old registered charity in the United Kingdom, publishes investigations and studies about digital privacy. It has challenged the legality of Britain’s spy agency using information obtained from the U.S. National Security Agency’s PRISM surveillance program to conduct mass surveillance of British citizens.

    Several of the firms alleged to have exported snooping gear to the region have Israeli connections. Verint’s exports, for example, were dispatched by its Israeli subsidiary, according to the report. According to Omanovic, multiple sources had told his group that the transfers had been approved by the Israeli government. Israel and Kazakhstan signed an agreement for defense trade and cooperation at the beginning of 2014. A spokesman at the Israeli embassy in Washington did not have any immediate comment. 

    The report also said the Israeli firm NICE Systems has supplied monitoring systems with mass surveillance capabilities to the Kazakh and Uzbek regimes. Erik Snyder, NICE’s director of Corporate Communications, told the group in response that NICE provides law enforcement agencies and intelligence organizations with solutions for lawful communication interception, collection, processing, and analysis, but that it “does not operate these systems, and has no access to the information gathered.” 

    Some of the U.S. companies named in the report allegedly provided the Central Asian governments with technology that has less controversial purposes. Sunnyvale, Ca.-based Juniper Networks manufactured broadband equipment that Kazakhstan has been using to transmit data, according to the report, and a surveillance system that actively monitors internet users is now operating from that equipment. But the report makes no claim about Juniper’s complicity in surveillance. Juniper spokeswoman Danielle Hamel said she would look into the claim but then did not respond further. 

    The sole international agreement that includes regulations for the export of mass surveillance technologies — known as the Wassenaar arrangement — is non-binding on its 41 signatories. Israel is not a signatory, but says it uses Wassenaar’s control list as a guide, according to Privacy International’s Omanovic. 

    In October 2014, the European Commission amended its export controls to impose extra licensing requirements on monitoring and interception technologies. But the U.S. has not enacted its own controls on such exports.

    Rep. Chris Smith, R-N.J., has introduced several versions of a bill entitled “The Global Online Freedom Act,” meant to “prevent United States businesses from cooperating with repressive governments in transforming the Internet into a tool of censorship and surveillance.” But he has not been able to get the bill approved even by the subcommittee on Africa, Global Health, Global Human Rights and International Organizations that he chairs.

    Julia Hartehttp://www.publicintegrity.org/authors/julia-hartehttp://www.publicintegrity.org/2014/11/21/16303/us-companies-supply-eavesdropping-gear-central-asian-autocrats

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    The conservative nonprofit American Commitment is amending its 2013 tax return with the Internal Revenue Service after questions this week from the Center for Public Integrity.

    The nonprofit — led by Phil Kerpen and receiving the majority of its funding from groups within the political network of billionaire brothers David and Charles Koch — misstated key identifying information abouttwo of the four nonprofits it financially supported last year in documents filed earlier this week with the IRS.

    Last year, American Commitment split $135,000 in donations among four groups, according to its new filing.

    Two of the beneficiaries — New Jersey Family First, which received $30,000, and FRC Action, which received $28,000 — are politically active "social welfare" nonprofits organized under Sec. 501(c)(4) of the tax code.

    However, the employer identification numbers listed by American Commitment in each case — known as EINs — belonged to related 501(c)(3) charities that, by law, can't engage in electoral politics.

    FRC Action is the political wing of the Family Research Council that describes itself as "dedicated to preserving and advancing the interests of family, faith and freedom in the political arena." New Jersey Family First, likewise, is the political arm of the New Jersey Family Policy Council, which describes itself as dedicated to "creating culture changers at home, in the church, in the voting booth and in the public square."

    During the 2014 election cycle, New Jersey Family First's political activity included spending about $25,000 to advocate against U.S. Sen. Cory Booker, D-N.J.

    Kerpen confirmed to the Center for Public Integrity that the money from American Commitment went to the 501(c)(4) arms of the groups.

    "We are correcting the erroneous EINs of 2013 grantees," Kerpen wrote in an email.

    When groups like American Commitment make grants to other organizations, the IRS requires, under the penalty of perjury, that they provide detailed information, including the full legal name of the beneficiary, the mailing address of each recipient organization, the organization's federal employer identification number and the section of the tax code under which the beneficiary is exempt.

    The other two beneficiaries of American Commitment's money 2013 were the Iowa-based American Future Fund, which received $65,000, and the Washington, D.C.-based Catholic Advocate, which received $12,000.

    Intentional misstatements on tax returns may invite enforcement actions by the IRS. Inadvertent mistakes, however, are less worrisome to the IRS so long as they're corrected — though they can be frustrating to those who use the documents to follow the money moving between organizations.

    "Accounting mistakes make tracking the flow of money all the more difficult," said Robert Maguire, a researcher at the Center for Responsive Politics, which monitors money in politics. "When organizations aren't careful how they report, it is more difficult, or even impossible, to document relationships between groups."

    Politically active nonprofits on both the left and right have been known to make mistakes on their annual tax returns.

    Earlier this year, for instance, both Patriot Majority USA, a liberal group, and Americans for Tax Reform, a conservative group, filed amended tax returns after they omitted information about their top vendors from recent filings, as the Center for Public Integrity previously reported.

    Screenshot from an ad sponsored by conservative group American Commitment.Michael Beckelhttp://www.publicintegrity.org/authors/michael-beckelhttp://www.publicintegrity.org/2014/11/21/16308/conservative-group-fumbles-disclosure-new-tax-document

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