Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
RIVERSIDE MEDICAL CENTER
Employer identification number
36-2414944
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(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?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
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.
Section B. Total Support
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).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
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.)
Section B. Total Support
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.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
10000128
Software Version:
v2010.1.0
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
RIVERSIDE MEDICAL CENTER
Employer identification number
36-2414944
Identifier
Return Reference
Explanation
Description of other program services
Form 990, Part III, Line 4d
ONCOLOGY - THE RUSH- RIVERSIDE CANCER INSTITUTE PROVIDES CARE TO PATIENTS ORIGINATING FROM THE 5 SURROUNDING COUNTIES. CANCER TREATMENTS BASED ON THE LATEST FINDINGS IN CANCER RESEARCH ARE PROVIDED BY BOARD CERTIFIED MEDICAL AND RADIATION ONCOLOGISTS AND NATIONALLY CERTIFIED ONCOLOGY NURSES. SERVICES INCLUDE HIGHLY INDIVIDUALIZED TREATMENT PLANS FOR SURGERY, MINIMALLY INVASIVE SURGERY, ROBOTIC SURGERY, CHEMOTHERAPY, MONOCLONAL ANTIBODY THERAPY, IMMUNOTHERAPY, HIGH-PRECISION RADIATION THERAPY, BLOOD TRANSFUSIONS, AND PAIN MANAGEMENT. TEAMS OF ONCOLOGY PHYSICIANS AND STAFF MEET TO SPECIFICALLY TAILOR PLANS TO THE INDIVIDUALS AND PROVIDE EXTENSIVE EDUCATION AND SUPPORT. THERE WERE OVER 14,400 SURGICAL, CHEMOTHERAPY, AND RADIATION PROCEDURES PERFORMED IN 2010.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE SOLE CORPORATE MEMBER OF RIVERSIDE MEDICAL CENTER 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, A RELATED TAX EXEMPT ORGANIZATION, HAS THE AUTHORITY TO ELECT AND/OR REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS OF THE CORPORATION.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE POWER AND AUTHORITY OF THE MEMBER CONCERNING THE AFFAIRS OF THE CORPORATION SHALL CONSIST OF THOSE RESERVED POWERS AS SET FORTH IN THIS SECTION. THE CORPORATION MAY, AT ITS OPTION, INITIATE OR 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 D/B/A RIVERSIDE HEALTHCARE 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 THE 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
MANAGEMENT PERFORMED THE INITIAL REVIEW OF THE FORM 990 AND THE PAID TAX PREPARER PRESENTED TO THE GOVERNANCE COMMITTEE. EVERY BOARD MEMBER ALSO RECEIVED A COPY OF THE FORM 990 PRIOR TO THE FORM BEING FILED 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 ANY 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
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 IS DONE ANNUALLY AND WAS LAST UNDERTAKEN IN 2010.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
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. POSITIONS FOR WHICH THIS PROCESS WAS USED ARE: - SENIOR VICE PRESIDENT & CHIEF OPERATING OFFICER - SENIOR VICE PRESIDENT FOR FINANCE & CHIEF FINANCIAL OFFICER - SENIOR VICE PRESIDENT FOR CORPORATE STRATEGY - VICE PRESIDENT FOR MEDICAL AFFAIRS - VICE PRESIDENT FOR PERI-OPERATIVE AND PROCEDURAL SERVICES - VICE PRESIDENT FOR PHYSICIAN PRACTICE MANAGEMENT - VICE PRESIDENT FOR NURSING SERVICES - VICE PRESIDENT FOR HUMAN RESOURCES - VICE PRESIDENT FOR SENIOR SERVICES THIS PROCESS WAS LAST UNDERTAKEN IN 2010.
Public Disclosure
Form 990, Part VI, Section C, Line 19
FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII
PHILLIP KAMBIC, PRESIDENT, AND BILL DOUGLAS, TREASURER, EACH DEVOTE APPROXIMATELY 1HR A WEEK TO EACH OF THE 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 - 11876649;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.