Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
RIVERSIDE MEDICAL CENTER |
362414944 | 3 | Yes | Yes | Yes | 4,312,174 | |||
| Total | 4,312,174 | ||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Classes of members or stockholders | Form 990, Part VI, Section A, Line 6 | THE SOLE CORPORATE MEMBER OF RIVERSIDE FOUNDATION TRUST IS RIVERSIDE HEALTH SYSTEM, A RELATED TAX EXEMPT ORGANIZATION. |
| Members or stockholders electing members of governing body | Form 990, Part VI, Section A, Line 7a | AS THE SOLE CORPORATE MEMBER, RIVERSIDE HEALTH SYSTEM HAS THE RIGHT TO APPOINT AND/OR REMOVE MEMBERS OF THE GOVERNING BODY. |
| Decisions requiring approval by members or stockholders | Form 990, Part VI, Section A, Line 7b | ACTION ON THE FOLLOWING MATTERS IS RESERVED EXCLUSIVELY TO THE MEMBER, PROVIDED THAT THE CORPORATION MAY, AT ITS OPTION, MAKE RECOMMENDATIONS TO THE MEMBER WITH RESPECT TO ANY OF THE FOLLOWING MATTERS: (A) ELECT AND REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION; (B) ELECT AND REMOVE THE PRESIDENT OF THE CORPORATION; (C) ADOPT, AMEND, RESTATE OR REPEAL THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; (D) AUTHORIZE THE CORPORATION TO ENGAGE IN, OR ENTER INTO ANY TRANSACTION PROVIDING FOR THE SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ASSETS OF THE CORPORATION OUTSIDE THE RIVERSIDE HEALTH SYSTEM CORPORATE STRUCTURE IN EXCESS OF FIVE PERCENT (5%) OF ITS ASSETS, AS DEFINED IN THE CORPORATE BOND INDENTURE, IN ANY TWELVE (12) MONTH PERIOD. (E) ADOPT A PLAN OF DISSOLUTION OR LIQUIDATION OF THE CORPORATION AND DISTRIBUTION OF ITS ASSETS; (F) ADOPT A PLAN OF MERGER, CONSOLIDATION OR CORPORATE REORGANIZATION INVOLVING THE CORPORATION OTHER THAN IN THE ORDINARY COURSE OF HEALTH CARE OPERATIONS; (G) AUTHORIZE ANY TRANSACTION WHICH WOULD RESULT IN A CHANGE IN OWNERSHIP OR CONTROL OF THE CORPORATION; (H) APPROVE THE APPOINTMENT OF AN INDEPENDENT AUDITOR OR THE ADOPTION OF ACCOUNTING POLICIES AND INVESTMENT GUIDELINES; (I) ADOPT CAPITAL AND OPERATING BUDGETS OF THE CORPORATION; (J) ADOPT AND EXECUTE A STRATEGIC PLAN OF THE CORPORATION; (K) INCUR INDEBTEDNESS IN EXCESS OF THE LIMITS ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (L) AUTHORIZE THE CORPORATION TO MAKE LOANS IN EXCESS OF THE LIMITS ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (M) AUTHORIZE ANY CAPITAL EXPENDITURES IN EXCESS OF LIMITS ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (N) AUTHORIZE ANY DONATION OF ASSETS OF THE CORPORATION IN EXCESS OF LIMITS ESTABLISHED BY THE MEMBER FROM TIME TO TIME; (O) AUTHORIZE SALE, TRANSFER, ENCUMBRANCE OR OTHERWISE DISPOSE OF ANY REAL PROPERTY OR INTEREST THEREIN OR THE PURCHASE OF ANY REAL ESTATE; (P) ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE OF THE CORPORATION ("AFFILIATE" SHALL INCLUDE ANY CORPORATION, ASSOCIATION, PARTNERSHIP, TRUST, JOINT VENTURE, OR OTHER ENTITY DIRECTLY OR INDIRECTLY CONTROLLING, CONTROLLED BY, OR UNDER COMMON CONTROL WITH THE CORPORATION); (Q) ESTABLISH POLICY GUIDELINES AND CRITERIA FOR IMPLEMENTATION OF THE CORPORATION'S MISSION AND PERIODICALLY REVIEW AND AMEND THE MISSION STATEMENT. (R) APPROVE ANY POLICY BY THE CORPORATION OR ANY ACTION TAKEN BY THE CORPORATION AS TO INITIATION, DEFENSE, OR SETTLEMENT OF LEGAL OR ADMINISTRATIVE ACTIONS IN EXCESS OF SUCH AMOUNTS AS SHALL BE ESTABLISHED PURSUANT TO CORPORATE POLICY. (S) MODIFY COMPENSATION AND BENEFIT POLICIES, WITH THE EXCEPTION OF THOSE INVOLVING THE PRESIDENT/CHIEF EXECUTIVE OFFICER, WHICH ARE SOLELY THE RESPONSIBILITY OF THE MEMBER'S EXECUTIVE COMMITTEE. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | FULL COMPLETE COPIES OF THE FORM 990 ARE PROVIDED TO THE ENTIRE GOVERNING BODY AND MANAGEMENT PRIOR TO FILING WITH THE IRS. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | THE CONFLICT OF INTEREST QUESTIONNAIRES ARE MAILED TO ALL BOARD MEMBERS ANNUALLY. EACH MEMBER MUST READ AND SIGN THE FORM TO DISCLOSE ANY POTENTIAL CONFLICTS FOR THE YEAR. IF A CONFLICT ARISES THE BOARD MEMBER IS MADE AWARE THAT THEY MUST ABSTAIN FROM VOTING ON AN ISSUE RELATED TO THE CONFLICT. THE PROCESS IS MONITORED BY THE ASSISTANT TO THE CEO. |
| Process used to establish compensation of top management official | Form 990, Part VI, Section B, Line 15a | THE CEO IS COMPENSATED BY RIVERSIDE MEDICAL CENTER (RMC), A RELATED TAX-EXEMPT ORGANIZATION. RMC'S COMPENSATION REVIEW PROCESS IS AS FOLLOWED: RIVERSIDE MEDICAL CENTER'S EXECUTIVE TOTAL COMPENSATION PROGRAM IS GOVERNED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF THE SYSTEM BOARD WHO HAVE NO PERSONAL INTEREST IN ANY EXECUTIVE COMPENSATION TRANSACTIONS. THE COMMITTEE GOVERNS THE SYSTEM'S EXECUTIVE TOTAL COMPENSATION PROGRAM FOR ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT, AND ABOVE. EACH YEAR THE COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IN DETERMINING APPROPRIATE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS. IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT INDEPENDENT COMPENSATION STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. THE COMMITTEE FOLLOWS ALL STEPS REQUIRED BY THE INTERNAL REVENUE SERVICE (IRS) TO QUALIFY FOR THE SAFE HARBOR UNDER THE INTERMEDIATE SANCTIONS REGULATIONS. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS AND DELIBERATIONS REGARDING COMPENSATION IN THE MINUTES ON A TIMELY BASIS. |
| Process used to establish compensation of other officers/key employees | Form 990, Part VI, Section B, Line 15b | THE OTHER OFFICERS ARE COMPENSATED BY RIVERSIDE MEDICAL CENTER. THE PROCESS USED BY RIVERSIDE MEDICAL CENTER IS PROVIDED BELOW. RIVERSIDE'S EXECUTIVE TOTAL COMPENSATION PROGRAM IS GOVERNED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF THE SYSTEM BOARD WHO HAVE NO PERSONAL INTEREST IN ANY EXECUTIVE COMPENSATION TRANSACTION. THE COMMITTEE GOVERNS THE SYSTEM'S EXECUTIVE TOTAL COMPENSATION PROGRAM FOR ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT, AND ABOVE. EACH YEAR THE COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO ASSIST IN DETERMINING APPROPRIATE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS. IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT INDEPENDENT COMPENSATION STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. THE COMMITTEE FOLLOWS ALL STEPS REQUIRED BY THE INTERNAL REVENUE SERVICE (IRS) TO QUALIFY FOR THE SAFE HARBOR UNDER THE INTERMEDIATE SANCTIONS REGULATIONS. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS AND DELIBERATIONS REGARDING COMPENSATION IN THE MINUTES ON A TIMELY BASIS. THIS PROCESS WAS LAST UNDERTAKEN IN 2010. |
| Public Disclosure | Form 990, Part VI, Section C, Line 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. PORTIONS OF THE FINANCIAL STATEMENTS ARE PUBLISHED IN THE ANNUAL REPORT WHICH IS MAILED TO THE LOCAL COMMUNITY. ALL OTHER GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| Average hours worked per week for related organization | Form 990, Part VII, Section A, Column B | MATT MCBURNIE - DEVOTES APPROXIMATELY 20 HOURS PER WEEK TO RIVERSIDE HEALTHCARE FOUNDATION, A RELATED TAX-EXEMPT ORGANIZATION. |
| HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII | PHILLIP KAMBIC, PRESIDENT, AND BILL DOUGLAS, TREASURER, EACH DEVOTE APPROXIMATELY 40 HOURS PER WEEK TO RIVERSIDE MEDICAL CENTER AND 1 HOUR PER WEEK TO EACH OF THE OTHER ENTITIES LISTED IN SCHEDULE R. VARIOUS BOARD MEMBERS ALSO CONTRIBUTE TIME TO RELATED ORGANIZATIONS REPORTED IN SCHEDULE R. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 285903; |
| Software ID: | 10000128 |
| Software Version: | v2010.1.0 |