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
INSTITUTE FOR DIVERSITY IN HEALTH MANAGEMENT INC
Employer identification number
58-2094118
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.") .
543,670
574,775
797,655
653,987
645,020
3,215,107
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......
269,560
88,051
157,733
88,060
320,125
923,529
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
813,230
662,826
955,388
742,047
965,145
4,138,636
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
32,500
95,000
160,000
100,000
250,050
637,550
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.
0
c
Add lines 7a and 7b..
32,500
95,000
160,000
100,000
250,050
637,550
8
Public Support (Subtract line 7c from line 6.)
3,501,086
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...
813,230
662,826
955,388
742,047
965,145
4,138,636
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
21,290
25,852
11,563
831
67
59,603
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
21,290
25,852
11,563
831
67
59,603
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
5,000
5,000
13
Total support (Add lines 9, 10c, 11 and 12.).
834,520
688,678
966,951
742,878
970,212
4,203,239
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
83.290 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
81.975 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
1.420 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
1.943 %
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
OTHER INCOME, SCHEDULE A, PART III, LINE 12, MISCELLANEOUS INCOME: 2010 - $5,000,
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
INSTITUTE FOR DIVERSITY IN HEALTH MANAGEMENT INC
Employer identification number
58-2094118
Identifier
Return Reference
Explanation
Description of other program services
Form 990, Part III, Line 4d
THE SUMMER ENRICHMENT PROGRAM (SEP) IS AN ENHANCED INTERNSHIP PROGRAM WHICH GIVES REAL-WORLD WORK EXPERIENCE TO GRADUATE STUDENTS IN HEALTH ADMINISTRATION WITH A 10-12 WEEK, PAID INTERNSHIP IN A HOSPITAL OR HEALTH CARE FACILITY. IN ADDITION TO GAINING BROAD EXPOSURE TO THE HOST INSTITUTE'S STAFF, STAKEHOLDERS AND CHALLENGES, SEP INTERNS ALSO COMPLETE AN INDEPENDENTLY DESIGNED SPECIAL PROJECT. EXPERIENCED ADMINISTRATORS SERVE AS PRECEPTORS AND MENTOR THE INTERNS, PROVIDING SUPPORT AND CAREER ADVICE AS WELL AS INTRODUCING THEM TO COLLEAGUES. THE SEP PROGRAM ALSO SERVES A SECONDARY PURPOSE IN INTRODUCING HOST HOSPITALS AND HEALTH CARE FACILITIES TO NEW, YOUNG HEALTH ADMINISTRATION GRADUATE STUDENTS FOR POSSIBLE CONSIDERATION FOR FUTURE EMPLOYMENT.
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
OUR VISION IS THAT THE MANAGEMENT AT HEALTH CARE INSTITUTIONS AROUND THE COUNTRY - IN URBAN AND RURAL AREAS, TEACHING AND NON-PROFIT FACILITIES - REFLECTS THE RICH CULTURAL AND ETHNIC DIVERSITY OF THE COMMUNITIES THEY SERVE.
PROGRAM SERVICE DESCRIPTION
FORM 990, PART III, LINE 4A
THE INSTITUTE MAINTAINS A CONFIDENTIAL REGISTRY OF SENIOR EXECUTIVES SEEKING NEW OPPORTUNITIES WHICH IS MATCHED WITH DAILY REQUESTS FOR QUALIFIED CANDIDATES. WE PROVIDE PROCEDURES FOR DEVELOPING CULTURALLY COMPETENT ORGANIZATIONS INCLUDING STAFF EDUCATIONAL TOOLS AND SUBJECT MATTER, INCLUDING CONTENT AND STATISTICS. WE FREQUENTLY PROVIDE TRAIN THE TRAINER SERVICES IN THE ARENA AND WE CONDUCT SITE VISITS UPON INVITATION. DISPARITIES REDUCTION INITIATIVES HAVE BEEN INCREASING DRAMATICALLY AND THE INSTITUTE PROVIDES REFERRALS FOR CONSULTANTS, SPEAKERS, AND TOOLS TO ASSIST HOSPITALS IN THIS VERY IMPORTANT WORK.
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
THE ORGANIZATION'S SOLE CORPORATE MEMBER IS AMERICAN HOSPITAL ASSOCIATION, A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, AMERICAN HOSPITAL ASSOCIATION HAS THE RIGHT TO ELECT OR APPOINT MEMBERS OF THE ORGANIZATION'S GOVERNING BODY AND APPROVE OR DENY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
SEE NARRATIVE FOR PART VI, LINE 6
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
SEE NARRATIVE FOR PART VI, LINE 6
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11b
THE ORGANIZATION'S MANAGEMENT REVIEWS THE FORM 990 AND SHARES IT WITH THE IFD BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
ON AN ANNUAL BASIS, THE ORGANIZATION'S TRUSTEES ARE REQUIRED TO READ, COMPLETE AND RETURN A CONFLICT OF INTEREST QUESTIONNAIRE. THE ORGANIZATION'S OFFICERS AND ALL OTHER EMPLOYEES ARE REQUIRED TO READ, COMPLETE AND RETURN A CONFLICT OF INTEREST QUESTIONNAIRE ON A BI-ANNUAL BASIS. THE RETURNED QUESTIONNAIRES ARE HANDLED JOINTLY BY LEGAL, HUMAN RESOURCES AND AUDIT AND COMPLIANCE STAFF. ANY QUESTIONNAIRE THAT RAISES A POTENTIAL ISSUE IS REVIEWED AND REFERRED TO THE ASSOCIATION'S PRESIDENT FOR A FINAL DETERMINATION OF ANY ACTION TO BE CONSIDERED OR UNDERTAKEN. ANY POTENTIAL CONFLICT OF INTEREST THAT ARISES AFTER THE QUESTIONNAIRE IS COMPLETED MUST BE PROMPTLY REPORTED. ANY RESTRICTIONS IMPOSED BASED ON INFORMATION DISCLOSED IN A CONFLICT OF INTEREST QUESTIONNAIRE OR OTHERWISE WOULD BE COMMENSURATE WITH THE TYPE OF CONFLICT IDENTIFIED AND WOULD BE DISCLOSED TO THE BOARD OF TRUSTEES.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
THE PRESIDENT OF IFD REPORTS TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) PRESIDENT. THE IFD BOARD, THE AHA PRESIDENT AND THE COMPENSATION COMMITTEE OF AHA PARTICIPATE IN SETTING GOALS FOR PERFORMANCE OF THE IFD PRESIDENT AND IN MEASURING PERFORMANCE AGAINST THESE GOALS. THE COMPENSATION COMMITTEE OF THE AHA BOARD DOES NOT INCLUDE ANY INDIVIDUAL WHOSE COMPENSATION IT REVIEWS. THE COMMITTEE ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO PRODUCE COMPARABLE SALARY DATA FOR THE PRESIDENT AS APPROPRIATE, AND MAKES RECOMMENDATIONS FOR COMPENSATION ADJUSTMENTS, CONSISTENT WITH EXISTING COMPENSATION AGREEMENTS, POLICIES AND PROCEDURES. ON AN ANNUAL BASIS, THE COMMITTEE EVALUATES THE PRESIDENT'S PERFORMANCE AGAINST ANNUAL PERFORMANCE GOALS AND DETERMINES WHETHER ANY ADJUSTMENT OR PERFORMANCE-BASED REWARD SHOULD BE MADE. THE FINAL COMPENSATION PACKAGE OF THE IFD PRESIDENT IS DOCUMENTED IN A WRITTEN EMPLOYMENT AGREEMENT. CONTEMPORANEOUS MINUTES OF THE COMMITTEE'S DELIBERATIONS ARE PREPARED AND REVIEW BY THE COMMITTEE IN A TIMELY MANNER.
Public Disclosure
Form 990, Part VI, Section C, Line 19
THE ORGANIZATION'S GOVERNING DOCUMENT AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104 AND ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS
FORM 990, PART VI, SECTION B, LINE 15B
THE COMPENSATION OF THE OTHER OFFICERS IS DETERMINED BY AN AMERICAN HOSPITAL ASSOCIATION (AHA) EXECUTIVE VICE-PRESIDENT AND THE IFD PRESIDENT. ON AN ANNUAL BASIS, THE AHA EXECUTIVE VICE-PRESIDENT AND THE IFD PRESIDENT EVALUATE THE OTHER OFFICER'S PERFORMANCE AGAINST ANNUAL PERFORMANCE GOALS AND DETERMINE WHETHER ANY ADJUSTMENT OR PERFORMANCE-BASED REWARDS SHOULD BE MADE. THE FINAL COMPENSATION PACKAGE OF THE OTHER OFFICERS IS DOCUMENTED IN A WRITTEN EMPLOYMENT AGREEMENT.
COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, ETC.
FORM 990, PART VII, SECTION A, LINE 1(A), COLUMN (B)
NEIL JESUELE, BOARD MEMBER, DEVOTES APPROXIMATELY 40 HOURS A WEEK TO AMERICAN HOSPITAL ASSOCIATION, A RELATED TAX-EXEMPT ORGANIZATION. R. JOHN EVANS, TREASURER, DEVOTES APPROXIMATELY 40 HOURS A WEEK TO AMERICAN HOSPITAL ASSOCIATION AND 1 HOUR A WEEK TO HEALTH RESEARCH AND EDUCATIONAL TRUST, BOTH OF WHICH ARE RELATED TAX-EXEMPT ORGANIZATIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.