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
EL PASO CHILDREN'S HOSPITAL CORPORATION
Employer identification number
26-3075429
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:
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
EL PASO CHILDREN'S HOSPITAL CORPORATION
Employer identification number
26-3075429
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
EL PASO CHILDREN'S HOSPITAL ENGAGES AN INDEPENDENT ACCOUNTING FIRM EXPERIENCED IN THE PREPARATION OF THE FORM 990 TO PREPARE ITS FORM 990. THE ORGANIZATION'S FINANCE AND LEGAL DEPARTMENTS REVIEW THE 990. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING THE 990.
FORM 990, PART VI, SECTION B, LINE 12C
EL PASO CHILDREN'S HOSPITAL'S CONFLICTS OF INTEREST POLICY REQUIRES HOSPITAL DIRECTORS, OFFICERS, MEDICAL STAFF MEMBERS, AND KEY EMPLOYEES (I.E., EMPLOYEES WHO HAVE THE ABILITY TO APPROVE OR ACTIVELY PARTICIPATE IN THE DECISION MAKING PROCESS WHEN NEGOTIATING A BUSINESS RELATIONSHIP THAT IS OF FINANCIAL OR MATERIAL INTEREST TO THE ORGANIZATION) TO REIVEW THE CONFLICTS OF INTEREST POLICY AND SIGN AN ACKNOWLEDGEMENT OF THE POLICY (I.E., RECEIPT, REIVEW, AND AGREEMENT TO COMPLY) BEFORE ELECTION/HIRE AND THEN AT LEAST ANNUALLY. ADDITIONALLY, EACH HAS A DUTY OF SELF-DISCLOSURE AS POTENTIAL AND/OR ACTUAL CONFLICTS ARISE. IT IS THE HOSPITAL'S STATED INTENT THAT A PERSON'S AFFILIATION WITH THE HOSPITAL IS BASED ON THE PERSON'S DESIRE TO ACT IN THE HOSPITAL'S BEST INTEREST RATHER THAN FOR PRIVATE GAIN. IT IS ALSO THE HOSPITAL'S STATED INTENT THAT IT DOES NOT DO BUSINESS WITH AN "INTERESTED PERSON."(A) BOARD OF DIRECTORS: BOARD MEMBERS ARE REMINDED OF THE DISCLOSURE REQUIREMENT AT EACH MEETING OF THE BOARD OF DIRECTORS. UPON DISCLOSURE OF A POTENTIAL OR ACTUAL CONFLICT, THE INDIVIDUAL MAY MAKE A BRIEF PRESENTATION TO THE BOARD OR PERTINENT COMMITTEE AND THEREAFTER MUST REFRAIN FROM FURTHER DISCUSSION OF THE MATTER. THE INDIVIDUAL MUST LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT GIVING RISE TO THE CONFLICT OF INTEREST. THE CHAIR OF THE BOARD OR COMMITTEE MAY, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE HOSPITAL AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IN MAKING ITS DETERMINATION, THE BOARD OR COMMITTEE SHALL EXERCISE GOOD FAITH AND THE LEVEL OF CARE THAT AN ORDINARILY PRUDENT PERSON IN A SIMILAR POSITION WOULD EXERCISE UNDER SIMILAR CIRCUMSTANCES. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL NOTIFY THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION THE BOARD OR COMMITTEE DETERMINES APPROPRIATE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE MEMBER IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST. IF THE BOARD OR COMMITTEE MAKES SUCH A DETERMINATION, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. ALL DISCUSSIONS PERTAINING TO POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MINUTES OF THE BOARD OR COMMITTEE. (B) HOSPITAL EMPLOYEES/MEDICAL STAFF: THE HOSPITAL CONFLICT OF INTEREST POLICY IS CONTAINED IN POLICY NUMBER CP-04, WHICH APPLIES TO EL PASO CHILDREN'S HOSPITAL AND ITS AFFILIATES. THE POLICY IS DESIGNED TO IDENTIFY AND ADDRESS POTENTIAL, ACTUAL, AND APPARENT CONFLICTS OF INTEREST. HOSPITAL EMPLOYEES/MEDICAL STAFF HAVE A DUTY TO SELF-DISCLOSE POTENTIAL AND ACTUAL CONFLICTS. CONFLICT OF INTEREST CERTIFICATION FORMS THAT IDENTIFY POTENTIAL CONFLICTS ARE REVIEWED BY THE HOSPITAL CHIEF EXECUTIVE OFFICER, COMPLIANCE OFFICER, AND GENERAL COUNSEL TO DETERMINE APPROPRIATE ACTION. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE HOSPITAL MAY NEVERTHELESS PROCEED WITH THE PROPOSED TRANSACTION OR ARRANGEMENT USING THE FOLLOWING PROCEDURES: A. THE COMPLIANCE OFFICER MAY ASK THE INTERESTED PERSON TO DISCUSS THE PROPOSED TRANSACTION IN ORDER TO OBTAIN FURTHER DETAILS. OTHER THAN THIS DISCUSSION, THE INTERESTED PERSON WILL REFRAIN FROM DISCUSSING THE PROPOSED TRANSACTION OR ARRANGEMENT WITH HOSPITAL OFFICIALS AND WILL NOT PARTICIPATE IN DECISION MAKING REGARDING THE PROPOSED TRANSACTION. B. THE COMPLIANCE OFFICER MAY, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. C. AFTER EXERCISING DUE DILIGENCE, THE COMPLIANCE OFFICER OR APPOINTEE(S) SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. D. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE COMPLIANCE OFFICER SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE HOSPITAL, AND SHALL MAKE A RECOMMENDATION TO THE CEO (OR DESIGNEE) AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE HOSPITAL PROCEEDS WITH THE PROPOSED TRANSACTION, THE COMPLIANCE OFFICER PREPARES A MEMORANDUM TO DOCUMENT THAT THE INTERESTED PERSON SHALL NOT PARTICIPATE IN DECISION MAKING AND SHALL HAVE NO OVERSIGHT OF THE VENDOR PAYMENT IN CONNECTION WITH THE TRANSACTION. COMPLIANCE IS MONITORED BY THE HOSPITAL'S COMPLIANCE OFFICER THROUGH INTERNAL AUDITS. ADDITIONALLY, THE HOSPITAL UTILIZES A COMPLIANCE HOTLINE AS AN ADDITIONAL REPORTING MECHANISM.
FORM 990, PART VI, SECTION B, LINE 15
EL PASO CHILDREN'S HOSPITAL DETERMINES COMPENSATION FOR ITS CEO AND OTHER OFFICERS AND KEY EMPLOYEES BY CONSIDERING SALARY RANGES, SALARY SURVEYS, AND MARKET ANALYSES FOR EACH POSITION. SPECIFICALLY, THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS SALARIES FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE BOARD OF DIRECTORS APPROVES SALARIES FOR THE CEO AND OTHER OFFICERS. THE CEO APPROVES SALARIES FOR KEY EMPLOYEES (DIRECTOR LEVEL AND BELOW).
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAILS COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND/OR FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST.
HOSPITAL OPERATIONS
FORM 990, PART IV, LINES 20A AND 20B
AT SEPTEMBER 30, 2011, THE EL PASO CHILDREN'S HOSPITAL WAS STILL IN THE START-UP PHASE AND HAD NOT YET BEGUN OPERATIONS. NO SERVICES HAD BEEN PROVIDED, NO PROGRAM SERVICE EXPENDITURES INCURRED, AND NO AUDITED FINANCIAL STATEMENTS PREPARED. THE HOSPITAL BEGAN OPERATIONS FEBRUARY 14, 2012.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.