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
MOUNT SINAI MEDICAL CENTER INSURANCE TRUST
Employer identification number
59-1830065
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
SEE PART IV
590624424
3
Yes
Yes
0
Total
0
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, PART IV, SUPPLEMENTAL INFORMATION: PART I, LINE H(A), COLUMN (I), NAME OF SUPPORTED ORGANIZATION: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
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
MOUNT SINAI MEDICAL CENTER INSURANCE TRUST
Employer identification number
59-1830065
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE PROCESS FOR REVIEW OF THE FORM 990 BY MEMBERS OF THE GOVERNING BODY AND MANAGEMENT IS AS FOLLOWS: THE MEMBERS OF THE GOVERNING BODY, MANAGEMENT, AND THE INDEPENDENT TAX CONSULTANTS HAVE MET AND REVIEWED IN DETAIL THE COMPLETED FORM 990. THE FOLLOWING MEMBERS OF THE GOVERNING BODY PERFORMED THE REVIEW ALONG WITH EXECUTIVE MANAGEMENT COMPOSED OF THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER, AND INDEPENDENT TAX CONSULTANTS: CHAIRMAN OF THE BOARD VICE-CHAIRMAN OF THE BOARD CHAIRMAN, FINANCE COMMITTEE CHAIRMAN, COMPLIANCE COMMITTEE CHAIRMAN, INVESTMENT COMMITTEE PRESIDENT, FOUNDATION CHAIRMAN, AUDIT COMMITTEE
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST POLICY: MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC. AND SUBSIDIARIES (THE "MEDICAL CENTER") FORMALLY IMPLEMENTED A WRITTEN CONFLICT OF INTEREST POLICY (THE "POLICY") ON MARCH 2006 TO PROTECT THE MEDICAL CENTER AND ENSURE THAT THE DELIBERATIONS AND DECISIONS MADE ON BEHALF OF THE MEDICAL CENTER ARE MADE IN THE BEST INTEREST OF THE MEDICAL CENTER. THE TERM "CONFLICT OF INTEREST" AS DEFINED BY THIS POLICY REFERS TO SITUATIONS IN WHICH FINANCIAL OR OTHER PERSONAL CONSIDERATIONS MAY COMPROMISE, OR HAVE THE APPEARANCE OF COMPROMISING, THE JUDGMENT OF SOMEONE CHARGED WITH THE RESPONSIBILITY TO ACT ON BEHALF OF THE MEDICAL CENTER. THIS POLICY IS REVIEWED PERIODICALLY BUT NOT LESS THAN ONCE A YEAR BY THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES TO BETTER MEET ITS OBJECTIVES. IT IS INTENDED TO SUPPLEMENT BUT NOT REPLACE ANY APPLICABLE LAWS GOVERNING CONFLICTS OF INTEREST IN NONPROFIT AND CHARITABLE ORGANIZATIONS. PERSONS COVERED UNDER THIS POLICY INCLUDE: (1) ANY CURRENT OR FORMER TRUSTEE, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS FOR THE MEDICAL CENTER; (2) MEMBERS OF MANAGEMENT AND ANY EMPLOYEE OF THE MEDICAL CENTER WHO: A) RECEIVES COMPENSATION FROM THE MEDICAL CENTER IN EXCESS OF $150,000 ANNUALLY, WHETHER AS A FULL- OR PART-TIME EMPLOYEE, INDEPENDENT CONTRACTOR, OR OTHERWISE, AND, B) HAS RESPONSIBILITIES, POWER OF INFLUENCE OVER AN ACTIVITY OF THE MEDICAL CENTER SIMILAR TO THAT OF AN OFFICER OR TRUSTEE AND WHICH REPRESENTS MORE THAN 10% OF THE ACTIVITIES, ASSETS, INCOME OR EXPENSES OF THE MEDICAL CENTER, AND C) IS ONE OF THE TWENTY EMPLOYEES WITH THE HIGHEST COMPENSATION FROM THE MEDICAL CENTER. (3) ANY PERSON(S) WHO SERVE AS A MEMBER OF THE MEDICAL CENTER'S MEDICAL STAFF AS A CHAIRPERSON OF A DEPARTMENT, CHIEF OF A CLINICAL SERVICE, OR MEMBER OF THE MEDICAL EXECUTIVE COMMITTEE. MONITORING AND COMPLIANCE: AN IMPORTANT STEP IN MONITORING AND ENFORCING COMPLIANCE WITH A CONFLICT OF INTEREST POLICY INCLUDES MANAGEMENT'S EDUCATION EFFORTS TO MAKE INTERESTED PERSONS AWARE OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. TO THAT END, MANAGEMENT HAS INCLUDED IN ITS CODE OF CONDUCT (THE "CODE") A SECTION ON CONFLICTS OF INTEREST WHICH HAS TO BE SIGNED AND RETURNED BY EVERY INTERESTED PERSON TO ACKNOWLEDGE AND ATTEST THAT THEY READ THE CODE INCLUDING THE CONFLICT OF INTEREST SECTION. ANNUALLY, INTEREST PERSONS ALSO RECEIVE A REFRESHER TRAINING SESSION ON ETHICS AND CONFLICTS OF INTEREST. IN ADDITION, THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES HAS CREATED A SUBCOMMITTEE ON CONFLICTS OF INTEREST ("CONFLICTS COMMITTEE") TO ADMINISTER AND MONITOR COMPLIANCE WITH THIS POLICY. THE CONFLICTS COMMITTEE REQUIRES A STATEMENT FROM EACH INTERESTED PERSON NOT LESS FREQUENTLY THAN ONCE A YEAR SETTING FORTH ALL BUSINESS AND OTHER AFFILIATIONS THAT RELATE IN ANY WAY TO THE BUSINESS AND OTHER ACTIVITIES OF THE MEDICAL CENTER. INTERNAL AUDIT COMPILES AND SUMMARIZES ALL THE DISCLOSURES RECEIVED FROM INTERESTED PERSONS TO FACILITATE THEIR REVIEW BY THE CONFLICTS COMMITTEE. THE CONFLICTS COMMITTEE INDIVIDUALLY DISCUSSES EACH DISCLOSURE TO EVALUATE WHETHER A CONFLICT OF INTEREST EXISTS AND DETERMINES THE APPROPRIATE COURSE OF ACTION TO TAKE. NEITHER THE BOARD NOR ANY COMMITTEE OF THE BOARD SHALL VOTE UPON ANY PROPOSED TRANSACTION OR ARRANGEMENT IN CONNECTION WITH A POTENTIAL CONFLICT OF INTEREST UNTIL SUCH TIME AS THE CONFLICTS COMMITTEE HAS DETERMINED WHETHER A CONFLICT OF INTEREST EXISTS. WHERE THE CONFLICTS COMMITTEE HAS CONCLUDED THAT A CONFLICT OF INTEREST EXISTS, THE CHAIRMAN OF THE CONFLICTS COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTEREST PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO A PROPOSED TRANSACTION, CONTRACT, OR ARRANGEMENT. IF THE CONFLICTS COMMITTEE DETERMINES THAT THE MEDICAL CENTER CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THEN THE MEDICAL CENTER SHALL NOT ENTER INTO THE TRANSACTION THAT INVOLVES THE CONFLICT OF INTEREST. IF A TRANSACTION OR ARRANGEMENT MORE ADVANTAGEOUS IS NOT REASONABLY ATTAINABLE UNDER THE CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THEN THE BOARD OR COMMITTEE, AS APPLICABLE, SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE MEDICAL CENTER'S BEST INTEREST AND WHETHER IT IS FAIR AND REASONABLE TO THE MEDICAL CENTER, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. FAILURE BY AN INTEREST PERSON TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST UNDER THE CONFLICT OF INTEREST POLICY IS CONSIDERED A SERIOUS MATTER AND MAY CONSTITUTE "CAUSE" FOR REMOVAL OR TERMINATION OF A TRUSTEE, OFFICER, OR THE TERMINATION OF ANY CONTRACTUAL OR EMPLOYMENT RELATIONSHIP THE MEDICAL CENTER MAY HAVE WITH AN INTERESTED PERSON OR OTHER PARTY.
FORM 990, PART VI, SECTION B, LINE 15
ON AN ANNUAL BASIS, THE MOUNT SINAI MEDICAL CENTER COMPENSATION COMMITTEE CONTRACTS WITH AN INDEPENDENT CONSULTANT TO PREPARE AN OPINION REGARDING THE REASONABLENESS AND COMPARABILITY OF THE TOTAL COMPENSATION PROVIDED TO ITS SENIOR OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE INFORMS THE INDEPENDENT CONSULTANT THAT THE INDEPENDENT CONSULTANT'S OPINION WILL BE PART OF THE COMMITTEE'S PROCEDURE FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS DESCRIBED IN THE INCOME TAX REGULATIONS. THE INDEPENDENT CONSULTANT'S DETERMINATION OF REASONABLENESS IS MADE AFTER A THOROUGH REVIEW OF ALL THE ELEMENTS OF THE TOTAL COMPENSATION COMPRISED OF: CASH COMPENSATION, HEALTH AND WELFARE BENEFITS, RETIREMENT BENEFITS, EXECUTIVE BENEFITS AND PERQUISITES, AND OTHER ELEMENTS OF COMPENSATION INCLUDING SEVERANCE ARRANGEMENTS. THE OPINION EXPRESSED BY THE INDEPENDENT CONSULTANT IS THEN PRESENTED TO THE MSMC COMPENSATION COMMITTEE IN A REPORT FORM FOR THEIR REVIEW. THE OPINION REPORT IS REFERRED TO BY THE COMPENSATION COMMITTEE WHEN DETERMINING AND APPROVING THE ANNUAL COMPENSATION FOR ITS SENIOR OFFICERS AND KEY EMPLOYEES. THE MSMC COMPENSATION COMMITTEE PRESENTS ITS DETERMINATION TO THE MSMC EXECUTIVE COMMITTEE FOR ITS FINAL APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19
FORM 990, PART VI, SECTION C, LINE 19: POLICY FOR ANNUAL INFORMATION REQUEST: DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
AVERAGE HOURS PER WEEK
PART VII, SECTION A, LINE 1, COLUMN B
THE OFFICERS LISTED ON PART VII, SECTION A, LINE 1(A), COLUMN B DEVOTED THEIR TIME TO THE ORGANIZATION AND RELATED ORGANIZATION AS FOLLOWS: MT SINAI MT SINAI MT SINAI MT SINAI MED CTR MED CTR MED CTR MEDICAL OF FL OF FL INSURANCE OFFICE FDN TRUST BLDG, II ALEXANDER MENDEZ 40.0 0.0 0.5 0.5 STEVEN SONENREICH 40.0 0.0 0.5 0.5
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -45.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.