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
Main Line Health Inc
Employer identification number
23-2331531
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)
MAIN LINE HOSPITALS INC
231352160
03
Yes
Yes
Yes
4,994,755
(2)
LANKENAU INSTITUTE FOR MEDICAL RESEARCH
232175659
04
Yes
Yes
Yes
52,151
(3)
RIDDLE MEMORIAL HOSPITAL
231529076
03
Yes
Yes
Yes
645,804
Total
5,692,710
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:
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
Main Line Health Inc
Employer identification number
23-2331531
Identifier
Return Reference
Explanation
FORM 990, Part III, Line 4d
Other program services for Main Line Health, Inc include expenses associated with a potential new site (Concord location), in additional to other general expenses and miscellaneous benefit costs. Part VI, Section A, Line 2 A board member's professional business of estate planning is utilized by certain other members of the board, thus establishing a professional business association. FORM 990, Part VI, Lines 6, 7a & 7b As per the Articles of Incorporation, the sole member of Main Line Health, Inc. is Jefferson Health System, a PA nonprofit corporation. As sole member, Jefferson Health System holds certain powers of election and approval in connection with the governing body of Main Line Health, Inc. These powers are presented in detail in the company's governing documents which the company makes available to the public upon request. FORM 990, Part VI, Line 11A The Form 990 is prepared in conjunction with PriceWaterhouseCoopers LLP and reviewed internally by management. It is then sent to the board of trustees for their review. The Form 990 is reviewed at a meeting of the Board of Trustees prior to filing.
FORM 990, Part VI, Line 12c
Annual conflicts of interest statements are required to be completed by all trustees, officers, directors, key employees and other interested persons. Any conflict arising are referred to the Governance Committee for resolution. If deemed necessary or advisable, cases may be referred to the Main Line Health board for resolution.
FORM 990, Part VI, Line 15
The Compensation paid to officers is paid by affiliates of the organization. The process for determining compensation for officers is as follows: Using the services of an independent consulting firm, JHS utilized no fewer than three executive compensation surveys in determining the compensation of the MLH CEO. JHS used market data representing functionally comparable jobs within similarly situated organizations in making these compensation determinations. After the review and deliberation of the Executive Committee of the JHS Board, which was the responsibilities of a Compensation Committee, compensation recommendations were reviewed and approved by the full JHS Board. The MLH CEO reports to the JHS CEO and is appointed by the JHS Board. The MLH CEO also reports the MLH Board. Further, The Human Resources & Compensation Committee of the Main Line Health Board, using the services of an independent Executive Compensation consulting firm is responsible for evaluating and determining the total Senior Executive benefits and compensation for the EVP & Chief Financial Officer, Hospital Presidents and other Senior Executives using both national and regional healthcare delivery market comparable compensation data. After review and deliberation the Committee documents its compensation decisions and reports to the full MLH Board of Governors who review and approve these compensation decisions.
FORM 990, Part VI, Line 19
The organization makes its governing documents, conflict of interest policy, and financial statements available upon request.
FORM 990, Part VII, Section A, Column B
The officers devote their time to all of the organizations within Main Line Health, Inc. As such, the total hours worked by the officers, across all of the organizations, cumulatively represent their full-time employment status.
Schedule K
On August 16, 2007, Pennsylvania Economic Development Financing Authority ("PEDFA") issued the Series 2007 Main Line Health Revenue Bonds (the "2007 Bonds"), maturing on October 1, 2027, in the amount of $34,650,000. The purpose of the issuance was to (i) redeem the Riddle Hospital Series of 1998 Bonds outstanding in the amount of $37,060,000; (ii) pay the costs incurred in connection with the issuance of the 2007 Bonds; and (iii) eliminate the 1998 Bond requirement to maintain a Debt Service Reserve Fund. The bondholders have a put option that can be exercised in August 2012, at which point the Bonds would be either remarketed or repurchased by MLH. The proceeds received by PEDFA were loaned to MLH and were used to refund the Riddle Hospital Revenue Bonds, Series of 1998. This bond liability is recorded on the balance sheet of Riddle Memorial Hospital. Additionally, On May 17, 2004 the Chester County Health and Education Facilities Authority (the "Authority") issued $67,140,000 of Health System Revenue Bonds, Series 2004A and 2004B ("2004 Bonds"). The proceeds received by the Authority were loaned to JHS and were used to refund the 1994 MLH bonds. MLH has agreed to pay JHS $129,303,000 pursuant to a Group Debt Allocation Agreement among JHS, TJUH, and MLH, which allocates among these affiliates, and certain of their respective members, the principal and interest owed in connection with the obligations incurred by JHS under a Master Indenture dated February 1, 1994, as amended and restated. This liability is recorded on the balance sheets of the respective members of the initial Obligated Group (Main LIne Hospitals, Inc. and Main Line Realty Corporation) as amounts due to JHS and included on Part X, Line 25 of each respective Form 990.
FORM 990, Part XI, Line 5
Other Changes in Net Assets include the following: Unrestricted-$12,842 unrealized gains on investments and a $350,000 pension adjustment. Temporarily Restricted-$107,454 unrealized gains on investments Permanently Restricted-$10,301 unrealized gains on investments
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.