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
Harvard Medical Collaborative Inc
Employer identification number
04-3476764
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)
Beth Israel Deaconess Medical Center Inc
042103881
501(c)(3)
Yes
Yes
Yes
596,585
(2)
Joslin Diabetes Center Inc
042203836
501(c)(3)
Yes
Yes
Yes
64,418
(3)
Children's Medical Center Corporation
041174680
501(c)(3)
Yes
Yes
Yes
720,346
(4)
President and Fellows of Harvard College
042103580
501(c)(3)
Yes
Yes
Yes
617,212
(5)
Dana Farber Cancer Institute Inc
042263040
501(c)(3)
Yes
Yes
Yes
460,768
(6)
Brigham & Women's Hospital Inc
042312909
501(c)(3)
Yes
Yes
Yes
714,000
Total
3,173,329
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
Harvard Medical Collaborative Inc
Employer identification number
04-3476764
Identifier
Return Reference
Explanation
Form 990, Part VI, Section A, line 2
The following pairs of individuals have business relationships with one another which arise from each set of individuals' mutual affiliation with one of HMC's Member organizations: -- David Ting, member of the Beth Israel Deaconess Medical Center, Inc. (BIDMC) governing board, and Eric Buehrens, Executive Vice President and COO of BIDMC; -- G. Marshall Moriarty, member of Brigham & Women's Hospital, Inc. (BWH) governing board, and Arthur Mombourquette, Vice President, Support Services of BWH; -- Stephen R. Karp, member of Children's Medical Center's governing board, and Stuart J. Novick, Senior Vice President and General Counsel of Children's Hospital; -- John O'Connor, member of Dana-Farber Cancer Institute, Inc. (DFCI) governing board, and Dorothy Puhy, Executive Vice President and Chief Financial Officer of DFCI; -- Richard Mills, Executive Dean for Administration of Harvard Medical School (Harvard), and Richard Shea, Associate Dean for Physical Planning and Facilities at Harvard; and -- John L. Brooks, III, member of Joslin Diabetes Center, Inc. (Joslin) governing board, and Rick Markello, Chief Financial Officer of Joslin.
Form 990, Part VI, Section A, line 6
The Members of the Organization are Beth Israel Deaconess Medical Center, Inc., Brigham and Women's Hospital, Inc., The Children's Medical Center Corporation, Dana-Farber Cancer Institute, Inc., Joslin Diabetes Center, Inc., and President and Fellows of Harvard College. At any special or regular meeting the Members may increase the number of Members and elect new Members to complete the number so fixed by a vote of majority of the Members then in office; or they may decrease the number of Members, but only to eliminate vacancies caused by the resignation, removal, or disqualification of one or more Members. Membership in the Organization shall be limited to organizations that are exempt from federal income taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code. Each Member shall continue to be a Member until it dissolves, resigns, is removed, or becomes disqualified.
Form 990, Part VI, Section A, line 7a
HMC has six Member Corporations, each of which is a corporation that is exempt from federal income taxation pursuant to the provisions of Section 501(c)(3) of the Internal Revenue Code. Under the HMC bylaws, each corporate Member appoints two directors to sit on the HMC Governing Board, one from such Member's senior management and the other from the Member's governing board (except that President and Fellows of Harvard College, "Harvard", may appoint an alternate in lieu of a Member of the Harvard governing board). The bylaws provide that the Directors appointed by each Member jointly have one vote, and in the event of any disagreement between such directors, the vote of such Member shall be disregarded. An appointed Director may be suspended or removed with or without cause by the Member that appointed such director.
Form 990, Part VI, Section A, line 7b
The authority of the Directors to exercise the following powers is conditioned upon approval by two-thirds of the total of the Members: a. To add new Members b. To change capital call obligations of the Members, if any c. To refinance or approve any unbudgeted debt instruments, bonds, notes, or guarantees d. To enter into or renegotiate any mortgages on or security interest in the Corporation's real property or physical plant, except for those mortgages or material liens entered into pursuant to previously approved financings. e. To add new customers f. To change auditors g. To file for bankruptcy h. To employ or terminate employment of the chief executive officer or chief financial officer of the Corporation. i. To make material changes in the sale or repurchase of energy from third parties j. To approve or make material changes to any standard user contract In addition to these reserved powers, the Members shall have such other powers and rights as the Directors may designate.
Form 990, Part VI, Section B, line 11
The Form 990, prepared by an independent public accounting firm, is reviewed by the President of Harvard Medical Collaborative, Inc. ("HMC"). The complete Form 990 is presented to the Audit Committee of HMC for review and discussion. A copy of the complete return is then provided to each member of the HMC Board of Directors prior to submission to the Internal Revenue Service.
Form 990, Part VI, Section B, line 12c
Harvard Medical Collaborative, Inc. (HMC) has a conflict of interest policy which establishes that directors, officers, and other necessary individuals have an ongoing duty to disclose the existence of financial interests which may result in a conflict of interest. To administer the conflict of interest policy, annually HMC distributes a copy of the policy along with a conflict of interest form. The conflict of interest form must be returned by each such individual annually to affirm that he or she (i) has received a copy of the conflict of interest policy, (ii) has read and understands the policy, and (iii) has agreed to comply with the policy. Any activity that requires action under the conflict of interest policy is subject to review and action through the Board of Directors and the organization's general counsel. Pursuant to the conflict of interest policy, certain activities which could create conflicts of interest are prohibited while other types of relationships are permitted, subject to compliance with disclosure and recusal requirements.
Form 990, Part VI, Section B, line 15a
During calendar year 2010, Mr. John Aubrecht was paid by President and Fellows of Harvard College (Harvard) and leased to Harvard Medical Collaborative, Inc. (HMC) for his role as President and Executive Director of HMC. Mr. Aubrecht commenced that role in September of 2010. The Executive Committee of HMC serves as the Organization's Compensation Committee. The process for determining the annual compensation for HMC's Executive Director included a comprehensive review by the Executive Committee. As part of the process of hiring Mr. Aubrecht as Executive Director, the Executive Committee consulted with senior human resources executives from two of the Member Organizations (BIDMC and Harvard) and hired an executive recruitment firm to gather comparable compensation data for experienced executives with energy business expertise and help set compensation limits. The Executive Committee reviewed and discussed the comparable compensation data and the proposed compensation terms for the Executive Director and approved the compensation arrangements for the Executive Director. The Executive Committee deliberations were documented in minutes, and the HMC Member Organizations also ratified, approved and confirmed the hiring and compensation of the Executive Director which approval was contemporaneously documented in minutes. During the period covered by this filing, HMC did not have any other officers or key employees that merited a compensation review process.
Form 990, Part VI, Section C, line 19
The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
Director Compensation:
Form 990, Part VII, Section A:
A majority of the Organization's directors are compensated by related organizations. However, the compensation reported in Part VII of Form 990 does not represent compensation for the individuals' services in their capacity as officers or directors of Harvard Medical Collaborative. Rather, this compensation reflects remuneration for services those individuals performed in their capacity as full-time employees of those related organizations.
Oversight of Audit
Form 990, Part XII, Line 2c:
In prior years, the Organization had their financial statements reviewed by an independent accounting firm. For the current filing period, the Organization received a full audit. The Organization has an audit committee that performs general oversight of the audit process.
Number of Employees:
Form 990, Part V, Line 2a:
During calendar year ended 2010, the Organization had no employees of its own. Rather, two individuals performed services to the Organization as "leased employees" from President and Fellows of Harvard College (Harvard). All appropriate tax forms were filed by Harvard for these individuals.
Written Whistleblower & Document Retention and Destruction Policy:
Form 990, Part VI, Line 13 & 14:
Currently, the Organization does not have a written whistleblower or document retention and destruction policy of its own. However, the Organization is guided by Harvard Medical School's written policies for these procedures. The Organization's board of directors is currently considering adopting whistleblower and document retention and destruction policies of its own.
Form 990, Part VI, Line 8b:
Currently, HMC contemporaneously documents meetings held and written actions undertaken by its Executive Committee, which has the authority to act on behalf of its governing body, the HMC Board of Directors. During the period covered by this filing, the HMC Executive Committee documented its written actions contemporaneously. Minutes of the HMC Executive Committee (which were held primarily as planning meetings at which binding corporate resolutions were very rarely taken) were recorded but not adopted contemporaneously.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.