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
MARTIN MEMORIAL MEDICAL CENTER INC
Employer identification number
59-0637874
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
MARTIN MEMORIAL MEDICAL CENTER INC
Employer identification number
59-0637874
Identifier
Return Reference
Explanation
Classes of members or stockholders
Form 990, Part VI, Section A, Line 6
MARTIN MEMORIAL HEALTH SYSTEMS, INC. A 501(C)(3) TAX EXEMPT CORPORATION, IS THE SOLE MEMBER OF MARTIN MEMORIAL MEDICAL CENTER, INC.
Members or stockholders electing members of governing body
Form 990, Part VI, Section A, Line 7a
THE MEMBER OF MARTIN MEMORIAL MEDICAL CENTER MAY SELECT, REPLACE OR REMOVE THE MEMBERS OF THE GOVERNING BODY.
Decisions requiring approval by members or stockholders
Form 990, Part VI, Section A, Line 7b
THE SOLE MEMBER OF THE MEDICAL CENTER EXPRESSLY RESERVES THE FOLLOWING POWERS, TO BE EXERCISED BY IT IN ITS SOLE DISCRETION: -TO SELECT OR REPLACE AND TO REMOVE, WITH OR WITHOUT CAUSE, DIRECTORS OF THE MEDICAL CENTER; AND -TO AMEND THE ARTICLES OF INCORPORATION; -TO AMEND THE BYLAWS OF THE MEDICAL CENTER; -ADOPT ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET OR ANY CHANGES THEREIN; -AUTHORIZE THE MEDICAL CENTER TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION WHICH IS NOT PROVIDED FOR IN AN ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET APPROVED BY THE SOLE MEMBER OF THE MEDICAL CENTER WHERE THE AMOUNT INVOLVED EXCEEDS $100,000.00; -ADOPT ANY NEW, OR ANY CHANGES TO THE EXISTING, LONG-TERM OR MASTER INSTITUTIONAL PLANS OF THE MEDICAL CENTER; -AUTHORIZE THE MEDICAL CENTER TO ENGAGE IN, OR ENTER INTO, ANY TRANS¬ACTION PROVIDING FOR OR REQUIRING A CERTIFICATE OF NEED. HOWEVER, THE PRESIDENT/ CEO OF THE MEDICAL CENTER, OR THE EXECUTIVE COMMITTEE OF THE SOLE MEMBER, MAY SUBMIT A LETTER OF INTENT AND/OR AN APPLICATION FOR A CERTIFICATE OF NEED AT ANY TIME WITHOUT PRIOR AUTHORIZATION. THE BOARD OF DIRECTORS OF THE SOLE MEMBER SHALL SUBSEQUENTLY EITHER RATIFY THE ACTION OR VOTE TO WITHDRAW THE LETTER OF INTENT OR THE APPLICATION. -ADOPT A PLAN OF DISSOLUTION OF THE MEDICAL CENTER; -AUTHORIZE THE MEDICAL CENTER TO ENGAGE IN, OR ENTER INTO, ANY TRANS¬ACTION PROVIDING FOR THE SALE, LEASE, MORTGAGE OR OTHER DISPOSITION OF THE ASSETS OF THE MEDICAL CENTER NOT CONTEMPLATED AS PART OF THE CAPITAL OR OPERATING BUDGET; HOWEVER, IT IS UNDERSTOOD THAT THIS DOES NOT PRECLUDE THE SALE OF FULLY DEPRECIATED ASSETS, ASSETS TO BE SCRAPPED AND TAKEN OUT OF SERVICE, OR ASSETS TO BE TRADED IN ON THE PURCHASE OF NEW ASSETS APPROVED AS PART OF THE BUDGETING PROCESS. -ADOPT A PLAN OF MERGER OR CONSOLIDATION OF THE MEDICAL CENTER WITH ANOTHER CORPORATION; -ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF, ANY SUBSIDIARY OR AFFILIATE OF THE MEDICAL CENTER ("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 MEDICAL CENTER).
Review of form 990 by governing body
Form 990, Part VI, Section B, Line 11a
THE FORM 990 IS E-MAILED (MAILED IF THE DIRECTOR DOES NOT HAVE E-MAIL) TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE FORM 990 BEING FILED. THE FORM 990 ALSO GOES THROUGH A PROCESS WHERE AT LEAST 2 MEMBERS OF MARTIN MEMORIAL'S ACCOUNTING STAFF, THE ASST VP OF FINANCE, THE CFO AND THE PRESIDENT OF MARTIN MEMORIAL REVIEWS THE 990 TO ENSURE THE ACCURACY AND COMPLETENESS OF THE RETURN PRIOR TO IT BEING FILED.
Conflict of interest policy
Form 990, Part VI, Section B, Line 12c
THE CORPORATE COMPLIANCE OFFICER SURVEYS EACH DIRECTOR, OFFICER AND KEY EMPLOYEE OF MARTIN MEMORIAL MEDICAL CENTER AND RELATED AFFILIATED COMPANIES. THESE ANNUAL SURVEYS ARE DESIGNED TO DETERMINE IF ANY POTENTIAL CONFLICTS OF INTEREST EXIST. THE CORPORATE COMPLIANCE OFFICER EDUCATES BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES OF THEIR RESPONSIBILITY TO REPORT ANY POSSIBLE CONFLICTS OF INTEREST THAT MAY ARISE BETWEEN ANNUAL SURVEYS. THE CORPORATE COMPLIANCE OFFICER ALSO MONITORS AND INVESTIGATES ANY POSSIBLE CONFLICTS THAT MAY ARISE. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL WITH THE CONFLICT WILL ABSTAIN FROM VOTING ON ANY ISSUES OR PARTICIPATING IN DISCUSSIONS THAT ARE RELATED TO THE CONFLICT OF INTEREST.
Process used to establish compensation of top management official
Form 990, Part VI, Section B, Line 15a
EXECUTIVE COMPENSATION AT MARTIN MEMORIAL HEALTH SYSTEM ("MMHS") IS GOVERNED AND CONTROLLED BY THE COMPENSATION & RETIREMENT COMMITTEE OF THE BOARD OF DIRECTORS ACCORDING TO POLICIES SET BY THE BOARD AS A WHOLE. THE COMMITTEE IS MADE UP ENTIRELY OF COMMUNITY LEADERS, NONE OF WHOM ARE EMPLOYED BY MARTIN MEMORIAL MEDICAL CENTER ("MMMC"). THE COMMITTEE DETERMINES PAY LEVELS AT MMHS IN COMPARISON WITH OTHER NOT-FOR-PROFIT HOSPITALS AND HEALTH SYSTEMS LIKE MMHS IN SIZE AND COMPLEXITY AND WHICH SERVE SIMILAR TYPES OF COMMUNITIES. IT LOOKS AT NATIONAL DATA BUT ALSO TAKES INTO CONSIDERATION DATA FROM SIMILAR HEALTH SYSTEMS IN THE SOUTHEAST REGION OF THE COUNTRY. THE COMMITTEE REVIEWS COMPARABILITY DATA ON SALARY LEVELS, INCENTIVE PAY, AND BENEFIT COSTS, ASSESSING EACH ELEMENT OF COMPENSATION INDEPENDENTLY AND TOTAL COMPENSATION IN AGGREGATE. THE COMMITTEE RETAINS INDEPENDENT CONSULTANTS TO GATHER COMPARABILITY DATA ON EXECUTIVE COMPENSATION IN THE MMHS' PEER GROUP. THESE CONSULTANTS REGULARLY ASSIST THE COMMITTEE IN MAKING ITS DETERMINATION THAT EXECUTIVE COMPENSATION AT MMHS REMAINS REASONABLE AND CONSISTENT WITH THE BOARD-APPROVED MMHS EXECUTIVE COMPENSATION PHILOSOPHY. THE COMMITTEE APPROVES COMPENSATION FOR ALL LISTED EXECUTIVES EVERY YEAR. THE COMMITTEE DILIGENTLY FOLLOWS BEST PRACTICES IN GOVERNING EXECUTIVE COMPENSATION, INCLUDING THE PROCESS PRESCRIBED BY THE IRS FOR GOVERNING EXECUTIVE COMPENSATION IN THE TAX-EXEMPT SECTOR. IT IS COMMITTED TO ACCURATELY DISCLOSING EXECUTIVE COMPENSATION ON FORM 990.
Process used to establish compensation of other officers/key employees
Form 990, Part VI, Section B, Line 15b
COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES FOLLOWS THE SAME PROCESS AS DESCRIBED IN PART VI, LINE 15A.
Public Disclosure
Form 990, Part VI, Section C, Line 19
MARTIN MEMORIAL MEDICAL CENTER DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PURSUANT TO IRC SECTION 6104, THE FORM 990 WHICH INCLUDES INCOME STATEMENT AND BALANCE SHEET IS AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO AVAILABLE ONLINE THROUGH THIRD PARTY REPORTING SERVICES.
HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A
AMY BARRY, ARTHUR BRINK, JR, DONNA GRIFFITH, EDMOND COLLINS, HOWARD ROBBINS, KAREN RIPPER, MARK COCORULLO, MARK ROBITAILLE, AND MIGUEL COTY EACH DEVOTE 1 HOUR/WEEK TO COASTAL CARE CORPORATION. DWIGHT DENNY, EVAN COLLINS, GEORGE LEHACH, JOHN ROEWENBERG, JOHN ZEIGLER, JR., MARK COCORULLO, MARK ROBITAILLE, MARY-JO HORTON, AND WILLIAM CARLSON EACH DEVOTE 1 HOUR/WEEK TO MARTIN MEMORIAL HEALTH SYSTEMS. DWIGHT DENNY, GEORGE LEHACH, JOHN LOEWENBERG, JOSEPH GAGE, MARK COCORULLO, LEE BOUGHNER, MARK ROBITAILLE, AND SHELLY GUERARD EACH DEVOTE 1 HOUR/WEEK TO MARTIN MEMORIAL FOUNDATION. ARTHUR BRINK, JR. DEVOTES 50 HOURS/WEEK TO MARTIN MEMORIAL FOUNDATION. MARK ROBITAILLE, MARY-JO HORTON, AND SHELLY GUERARD EACH DEVOTE 1 HOUR/WEEK TO MARTIN MEMORIAL HOSPITAL AUXILIARY.
Other changes in net assets or fund balances
Form 990, Part XI, Line 5
NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -5965545; TRANSFER TO AFFILIATE - -9480261; CHANGE IN VALUE NET ASSETS HELD AT MARTIN FOUNDATION - 2839644; RESTRICTED FUND TRANSFER - -3142059; MIN PENSION LIABILITY ADJUSTMENT - -550990; MIN SERP LIABILITY ADJUSTMENT - 1071986; RETIREE HEALTH LIABILITY ADJUSTMENT - -1354794;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.