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
ANAHEIM MEMORIAL MEDICAL CENTER
Employer identification number
95-1966746
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.") .
291,133
216,340
257,396
507,310
0
1,272,179
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......
206,532,469
208,524,974
200,242,691
3,678,562
4,835,986
623,814,682
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.
206,823,602
208,741,314
200,500,087
4,185,872
4,835,986
625,086,861
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.)
625,086,861
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...
206,823,602
208,741,314
200,500,087
4,185,872
4,835,986
625,086,861
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
356,501
166,548
125,027
155,157
72,743
875,976
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
356,501
166,548
125,027
155,157
72,743
875,976
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
0
0
0
0
0
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.).
207,180,103
208,907,862
200,625,114
4,341,029
4,908,729
625,962,837
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
99.860 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.858 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.140 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.142 %
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:
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
ANAHEIM MEMORIAL MEDICAL CENTER
Employer identification number
95-1966746
Identifier
Return Reference
Explanation
INDEPENDENT VOTING BOARD MEMBERS
FORM 990, PART I, LINE 4 AND PART VI, LINE 1B
ALTHOUGH ANAHEIM MEMORIAL MEDICAL CENTER HAS 0 INDEPENDENT BOARD MEMBERS, THE ORGANIZATION IS CONTROLLED AND OVERSEEN BY A RELATED TAX-EXEMPT PARENT ORGANIZATION, MEMORIAL HEALTH SERVICES (MHS), WHICH DOES HAVE INDEPENDENT BOARD MEMBERS.
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, LINE 6
MEMORIAL HEALTH SERVICES IS THE SOLE CORPORATE MEMBER OF ANAHEIM MEMORIAL MEDICAL CENTER.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS
FORM 990, PART VI, LINE 7A
THE MEMORIAL HEALTH SERVICES (MHS) BOARD, AS THE RELATED TAX-EXEMPT PARENT ORGANIZATION AND CORPORATE MEMBER OF ANAHEIM MEMORIAL MEDICAL CENTER, APPOINTS THE MEMBERS OF ALL THE SUBSIDIARY BOARDS. THE MHS BOARD ALSO ELECTS ITS OWN MEMBERS TO SERVE.
DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS
FORM 990, PART VI, LINE 7B
THE EXERCISE OF THE FOLLOWING POWERS IS RESERVED TO THE CORPORATION'S MEMBER, MEMORIAL HEALTH SERVICES: A. ADOPT MISSION, PHILOSOPHY AND VALUES STATEMENTS OF THE CORPORATION AND ANY AMENDMENTS OR SUPPLEMENTS TO SUCH STATEMENTS. B. AMEND ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. C. ELECT AND REMOVE DIRECTORS OF THE CORPORATION. D. SELL, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION. E. MERGE, CONSOLIDATE OR VOLUNTARILY DISSOLVE THE CORPORATION. F. FORM A SUBSIDIARY OR ENTER INTO AN AGREEMENT TO ACT AS A GENERAL PARTNER. G. RETAIN AN ATTORNEY OR FIRM OF ATTORNEYS TO PROVIDE LEGAL SERVICES FOR THE CORPORATION. H. AUTHORIZE THE PURCHASE OF INSURANCE PROVIDING COVERAGE FOR THE CORPORATION AND ITS PROPERTIES, AS WELL AS THE ESTABLISHMENT AND OPERATION OF A PROGRAM OF RISK MANAGEMENT. I. RETAIN AN ACCOUNTANT OR FIRM OF ACCOUNTANTS TO PROVIDE ACCOUNTING AND AUDITING SERVICES FOR THE CORPORATION. J. ADOPT ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE CORPORATION. K. INCUR INDEBTEDNESS, AS SO DEFINED, IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES; L. AUTHORIZE ANY UNBUDGETED EXPENDITURE IN EXCESS OF $250,000 FOR CAPITAL IMPROVEMENTS TO THE PROPERTIES OWNED BY THE CORPORATION AND NOT APPROVED BY THE BUDGET PROCEDURE. M. ADOPT A STRATEGIC LONG-RANGE OR MASTER PLAN FOR THE CORPORATION AND TO RETAIN ANY CONSULTANTS WITH RESPECT THERETO.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990
FORM 990, PART VI, LINE 11B
THE SR. VP OF FINANCIAL OPERATIONS AND THE CFO/TREASURER REVIEWED THE 990 IN DETAIL AND THEN REVIEWED WITH THE ENTIRE BOARD PRIOR TO BEING FILED WITH THE IRS.
ADOPTION OF CONFLICT OF INTEREST POLICY
FORM 990, PART VI, LINE 12A
ANAHEIM MEMORIAL MEDICAL CENTER HAS THE FOLLOWING CONFLICT OF INTEREST POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2011.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST
FORM 990, PART VI, LINE 12C
THE GENERAL COUNSEL'S OFFICE (OF MEMORIAL HEALTH SYSTEM) ANNUALLY SURVEYS EACH DIRECTOR AND OFFICER AND REQUIRES AFFIRMATION THAT THE CONFLICT OF INTEREST POLICY HAS BEEN READ AND UNDERSTOOD. THE RESULTS OF THE SURVEY ARE REPORTED TO THE GOVERNANCE COMMITTEE OF THE PARENT WHICH COMMITTEE IS RESPONSIBLE FOR GOVERNANCE OVERSIGHT AND NOMINATIONS. CONFLICTS ARE EVALUATED FOR BEING OCCASIONAL OR DISABLING IN NATURE. THE GENERAL COUNSEL MAKES THE INITIAL EVALUATION AND ADVISES THE GOVERNANCE COMMITTEE IN ITS DELIBERATIONS. IF AND AS AN OCCASIONAL CONFLICT IS IDENTIFIED, THE GENERAL COUNSEL ADVISES THE SUBJECT DIRECTOR AND GOVERNANCE IN A "REBUTTABLE PRESUMPTION" TYPE PROCESS. SHOULD A DISABLING CONFLICT BE IDENTIFIED, THE DIRECTOR RESIGNS OR IS REMOVED UPON THE RECOMMENDATION OF THE GENERAL COUNSEL, GOVERNANCE COMMITTEE AND BOARD. IN ADDITION, AN ANNUAL NOTICE IS SENT BY EMAIL TO EACH EMPLOYEE HAVING EMAIL REGARDING THE ACCEPTANCE OF GIFTS.
ADOPTION OF WHISTLEBLOWER POLICY
FORM 990, PART VI, LINE 13
ANAHEIM MEMORIAL MEDICAL CENTER HAS A WHISTLEBLOWER POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2011.
ADOPTION OF DOCUMENT RETENTION AND DESTRUCTION POLICY
FORM 990, PART VI, LINE 14
ANAHEIM MEMORIAL MEDICAL CENTER HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2011.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN
FORM 990, PART VI, LINES 15A AND 15B
VP'S AND ABOVE (INCLUSIVE OF CEO'S) COMPENSATION IS REVIEWED BY AN EXTERNAL CONSULTANT WITH FINAL REVIEW AND APPROVED BY THE MHS BOARD OF DIRECTORS AND THEIR OUTSIDE COUNSEL. ALL MARKET DATA IS OBTAINED FROM THIRD PARTY SURVEY SOURCES. MARKET DATA REVIEWS ARE COMPLETED CONSISTENTLY ON AN ANNUAL BASIS. EXECUTIVES WERE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE ON 10/24/11. THE PROCESS OF DETERMINING COMPENSATION IS DOCUMENTED IN THE MINUTES OF THE MEMORIAL HEALTH SERVICES BOARD.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC
FORM 990, PART VI, LINE 19
THE CONFLICT OF INTEREST POLICY IS ON THE MHS WEBSITE. FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. GOVERNING DOCUMENTS ARE NOT AVAILABLE AT THIS TIME.
HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII
BARRY ARBUCKLE IS THE PRESIDENT/CEO OF ANAHEIM MEMORIAL MEDICAL CENTER (AMMC) AND THE TAX-EXEMPT PARENT, MEMORIAL HEALTH SERVICES (MHS). HE SERVES ON THE BOARD OF LONG BEACH MEMORIAL MEDICAL CENTER (LBMMC), MEMORIALCARE MEDICAL FOUNDATION (MMF), ORANGE COAST MEMORIAL MEDICAL CENTER (OCMMC), AND SADDLEBACK MEMORIAL MEDICAL CENTER (SMMC). HE IS ALSO THE CHAIRMAN OF THE BOARD OF DIRECTORS OF NATIONAL HEALTHCARE SERVICES (NHS), A RELATED FOR-PROFIT ENTITY. HE DEVOTES 50 HOURS PER WEEK TO MHS, 2 HOURS PER WEEK TO LBMMC, NHS, OCMMC, AND SMMC AND 1 HOUR PER WEEK TO MMF. THE COMPENSATION REPORTED ON PART VII AND SCHEDULE J FOR BARRY ARBUCKLE REPRESENTS HIS ENTIRE COMPENSATION, WHICH WAS PAID BY MHS. RICHARD GRANIERE IS THE CFO/TREASURER OF ANAHEIM MEMORIAL MEDICAL CENTER (AMMC) AND SERVES AS CFO/TREASURER OF THE TAX-EXEMPT PARENT, MEMORIAL HEALTH SERVICES (MHS). WITHIN HIS ROLE AT MHS, HE DEVOTES 51 HOURS PER WEEK TO MHS AND 2 HOURS PER WEEK TO EACH OF THE FOLLOWING: LBMMC, MMF, OCMMC, AND SMMC. THE COMPENSATION REPORTED ON PART VII AND SCHEDULE J FOR RICHARD GRANIERE REPRESENTS HIS ENTIRE COMPENSATION, WHICH WAS PAID BY MHS. KAREN TESTMAN IS THE SENIOR VICE PRESIDENT OF FINANCIAL OPERATIONS OF ANAHEIM MEMORIAL MEDICAL CENTER (AMMC) AND THE TAX-EXEMPT PARENT, MEMORIAL HEALTH SERVICES (MHS). WITHIN HER ROLE AT MHS, SHE DEVOTES 51 HOURS PER WEEK TO MHS AND 2 HOURS PER WEEK TO EACH OF THE FOLLOWING RELATED ORGANIZATIONS: LBMMC, MMF, OCMMC, AND SMMC. THE COMPENSATION REPORTED ON PART VII AND SCHEDULE J FOR KAREN TESTMAN REPRESENTS HER ENTIRE COMPENSATION, WHICH WAS PAID BY MHS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
FORM 990, PART XI, LINE 5
EQUITY TRANSFER TO MEMORIAL HEALTH SERVICES ($8,342,976) MINIMUM PENSION LIABILITY $5,106,191 ROUNDING ($ 1) ------------ TOTAL ($3,236,786)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.