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
Sinai Health System
Employer identification number
36-3166895
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)
Sinai Community Institute
363932824
Healthcare
No
309,641
(2)
Schwab Rehabilitation
362179802
Healthcare
No
2,074,058
(3)
Mount Sinai Community Foundation
363305449
Healthcare
No
1,416,927
(4)
Mount Sinai Hospital
361509000
Healthcare
No
15,455,555
Total
19,256,181
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:
10000105
Software Version:
2010v3.2
-
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
Sinai Health System
Employer identification number
36-3166895
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Governing documents, conflict of interest and financial statements are made available upon request and after review by management.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
Sinai Health System has an Executive Compensation Committee to support the organizational performance of Sinai Health System and its related entities through the alignment of executive compensation with system strategies and programs and ensure compliance with applicable law. The voting members of the Committee are independent members of the Board of Directors. The Committee meets twice annually or more frequently as circumstances require. The Committee establishes detailed goals annually for the President and CEO and other executives, and reviews performance against these goals on an annual basis. The Committee annually engages an outside, independent compensation consultant to benchmark the salaries and benefits of the organization's Assistant Vice Presidents and above, as well as a few directors. Compensation is based on detailed written performance appraisals and external market data. In executive session, the Committee reviews the performance of the President and CEO, each element of compensation, data of compensation programs in effect for CEOs of comparable organizations, and conducts an annual review of CEO performance against established goals. The Committee maintains written minutes which are maintained in Executive Administration.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The Conflict of Interest Disclosure Form is completed and signed annually by all board members, employed physicians, management personnel as well as other employees who are in a position to influence purchasing decisions. In addition to the annual filing of the form, an update is required to be filed any time there has been a change. Based on the information disclosed, the Chief Integrity Officer, along with other members of management and counsel as needed implements an appropriate conflict management plan, which may include requiring the interested party to abstain from participation in certain decisions. The information disclosed also is taken into consideration in making Board and Committee assignments. Further, board members are required to disclose potential conflicts relating to Board and Committee proceedings to the appropriate Board and/or Committee Chair for appropriate conflict management procedures, including abstention from participation in certain decisions.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
The 990 was initially prepared by the Finance Staff with multi disciplinary inputfrom Public Affairs, Corporate Integrity and other appropriate staff of theorganization. The 990 was then reviewed by Senior Finance staff and other members ofSenior Leadership. Ernst & Young,LLP reviewed the return for the organization. Priorto the filing, the 990 was reviewed and discussed with the Executive Committee ofthe Board of Directors. The 990 was also made available to the full Board ofDirectors.
Form 990, Part VI, Line 2
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et
Ellen Havdala has family relationship with Henri Havdala, M.D. and Leslie Mitchel-Bond has family relationship with Michael Mitchel.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: Support from the Aids Foundation of Chicago allows Sinai to provide Primary and HIV medical specialty care to 85 uninsured clients in our Adult Infectious Disease clinic. Aids FoundationProvides medical and social support case management services to all qualified HIV infected patients. This included food vouchers, transportation back and forth to visits, support systems, linkage into care, and referrals sources. Our case load is approximately 170. OTHER PROGRAM SERVICES 5: Michael Reese Health Trust:Evaluation of MRHT Deaf Project, Improve Respiratory Outcomes and Minimize Emergency Department Use and Evaluation of Sinai Community Institute Programs OTHER PROGRAM SERVICES 6: The Sinai Urban Health Institute (SUHI) began work on an evaluation grant from the Chicago Community Trust (CCT). The purpose of this grant is to provide an evaluation framework for Trust-funded health programs, thereby allowing for critical program review by both grantee organizations and the Trust. This project was conceptualized because many community-based health programs funded by the Trust do not have a structured evaluation plan in place, making it difficult to discern program effectiveness. The SUHI evaluator has developed working relationships with eight CCT health grantees over the course of the program's existence. Current and former partner organizations include:The Asian Health Coalition The Cambodian Association of IllinoisThe Humboldt Park Community of WellnessThe Ethiopian Community Association of ChicagoMt. Sinai's Pediatric Weight Management ProgramWestside Health AuthorityThe American Indian CenterSouth Central Community Services OTHER PROGRAM SERVICES 7: Other Programs include the Stand Against Cancer Evaluation,The Jewish Day School Wellness Initiative and mental health care. The Stand Against Cancer Evaluation project is a subcontract with Access Community Health Network which receives funding from the state of Illinois for this project to provide breast health services to women who cannot afford it on their own. Our work is to evaluate the program and give feedback to ACHN about its workings. SAC has been reducing our participation in the process over the years and we now have only a time FTE person working on this grant.For the Jewish Day School Wellness Initiative programa, Sinai Urban Health Institute used findings from the Jewish Community Health Survey of West Rogers Park/Peterson Park to develop and implement a five-year, multi-component obesity prevention program for the Jewish school system in Chicago. The initiative focused on effecting change at the individual, family, and school level within the following areas: health education, physical education, family involvement, school environment, staff wellness, and mental health. The Jewish Day School Wellness Initiative grew to involve as many as 4,382 students, through the school-based intervention, new community-level after-school recreation options, and competitive wellness incentive grants. Substantial changes at the school and individual-level were documented, including: the development of school wellness councils and active participation of parents and school personnel in creating school-based changes; improvement in the nutritional value of foods served at class parties; significant increases in student knowledge of healthy foods and behaviors; the development and distribution of health education curricula; purchase of physical education equipment to expand exercise offerings for students; and increased access to mental health services for girls.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.