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
FOUNDATION OF YUMA REGIONAL MEDICAL CENTER
Employer identification number
51-0179146
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.") ....
1,338,663
959,061
1,056,339
884,685
892,604
5,131,352
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..
1,338,663
959,061
1,056,339
884,685
892,604
5,131,352
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)..
191,892
6
Public Support. Subtract line 5 from line 4.
4,939,460
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..
1,338,663
959,061
1,056,339
884,685
892,604
5,131,352
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
152,686
221,249
122,012
120,532
146,792
763,271
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..
359,325
253,432
295,953
278,615
45,250
1,232,575
11
Total support (Add lines 7 through 10).
7,127,198
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
69.300 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
60.000 %
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, PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: OTHER INCOME IS TOTAL RECEIPTS FOR BENEFITS RECEIVED BY ATTENDEE'S OF THE FOLLOWING SPECIAL FUNDRAISING EVENTS: GOLF TOURNAMENT, TRACTOR RODEO AND SUNRISE BREAKFAST.
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
FOUNDATION OF YUMA REGIONAL MEDICAL CENTER
Employer identification number
51-0179146
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM BASED ON INFORMATION PROVIDED BY THE FINANCE DEPARTMENT. THE 990 IS THEN REVIEWED BY MANAGEMENT IN THE FINANCE DEPARTMENT. THE 990 IS PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12
THE FOUNDATION OF YRMC RECOGNIZES THAT THE POTENTIAL FOR CONFLICTS OF INTEREST EXISTS FOR DECISION-MAKERS AT ALL LEVELS WITHIN THE ORGANIZATION. LEVELS WITHIN THE ORGANIZATION INCLUDE VOLUNTEERS AND BOARD MEMBERS. THE FOUNDATION REQUIRES THE DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST SO THAT APPROPRIATE ACTION MAY BE TAKEN TO ENSURE THAT SUCH CONFLICTS WILL NOT INAPPROPRIATELY INFLUENCE IMPORTANT DECISIONS. BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY AND ALL POTENTIAL CONFLICTS OF INTEREST THAT COULD INAPPROPRIATELY INFLUENCE DECISIONS. THIS WOULD INCLUDE BECOMING INVOLVED AS A VENDOR OR RECEIVING REMUNERATION OF OTHER BENEFIT FROM A VENDOR. THIS INCLUDES IMMEDIATE FAMILY MEMBERS. IF A TRANSACTION IS PLANNED, THE BOARD MEMBER MUST DISCLOSE THE FOLLOWING INFORMATION TO THE FOUNDATION DIRECTOR: THE BOARD MEMBER'S OR FAMILY MEMBER'S PERSONAL INTEREST AND A DESCRIPTION OF THE PROPOSED TRANSACTION INCLUDING ALL RELEVANT INFORMATION. DOCUMENTS SIGNED BY MEMBERS OF THE FOUNDATION BOARD OF DIRECTORS ARE KEPT WITH THE BOARD COORDINATOR.
FORM 990, PART VI, SECTION B, LINE 15A
THE COMPENSATION OF THE EXECUTIVE DIRECTOR OF THE FOUNDATION OF YUMA REGIONAL MEDICAL CENTER IS DETERMINED BY THE FOUNDATION BOARD. THE FOUNDATION USES THE SAME PROCEDURES AS YUMA REGIONAL MEDICAL CENTER, THE TAX-EXEMPT PARENT OF THE FOUNDATION. THE POLICY IS AS FOLLOWS: THE BOARD OF YUMA REGIONAL MEDICAL CENTER HAS ADOPTED A COMPETITIVE PAY STRATEGY IN ORDER TO ATTRACT AND RETAIN QUALIFIED EXECUTIVES TO LEAD OUR ORGANIZATION AND TO FAIRLY COMPENSATE EXECUTIVES FOR ADVANCING THE MISSION OF YUMA REGIONAL MEDICAL CENTER. THE POLICY IS ALSO INTENDED TO ESTABLISH A FORMAL, CONSISTENT PROCESS FOR GOVERNING EXECUTIVE COMPENSATION DECISIONS. THIS PROCESS IS MEANT TO ESTABLISH A "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER IRC SECTION 4958. TO SECURE A LEGAL "REBUTTABLE PRESUMPTION OF REASONABLENESS" IN DETERMINING COMPENSATION OF THE CEO AND OTHER EXECUTIVES CONSIDERED DISQUALIFIED INDIVIDUALS, AN OUTSIDE CONSULTANT IS ENGAGED PERIODICALLY TO PROVIDE COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION IN SETTING UP TOTAL COMPENSATION PACKAGES INCLUDING AN INCENTIVE PAY PROGRAM KNOWN AS "PAY AT RISK" AND EXECUTIVE RETIREMENT PROGRAMS. I. OUR TOTAL COMPENSATION PHILOSOPHY IS COMPRISED OF THE FOLLOWING ELEMENTS: A. ROLE OF THE EXECUTIVE COMMITTEE THE BOARD'S EXECUTIVE COMMITTEE, AFTER REVIEWING THE MATERIAL PROVIDED BY THE CONSULTANT, SETS THE COMPENSATION FOR THE PRESIDENT/CEO AS WELL AS THE COMPENSATION POLICY AND STRATEGY FOR OTHER EXECUTIVES. THE EXECUTIVE COMMITTEE WILL REVIEW AND APPROVE, OR MODIFY AS APPROPRIATE, THE CEO'S RECOMMENDATIONS FOR OTHER EXECUTIVES. THE EXECUTIVE COMMITTEE PRESENTS ITS RECOMMENDATIONS TO THE FULL BOARD FOR ENDORSEMENT. B. PEER GROUP A NATIONAL PEER GROUP OF HEALTH CARE ORGANIZATIONS COMPARABLE TO YRMC IN REVENUE, STRUCTURE, MISSION AND SCOPE OF OPERATIONS WILL BE USED IN COLLECTING COMPARABILITY DATA. C. COMPETITIVE POSITIONING SALARY RANGE MIDPOINTS ARE SET AT THE 60TH PERCENTILE OF THE PEER GROUP. INDIVIDUAL SALARIES ARE POSITIONED WITHIN THE SALARY RANGES BASED ON FACTORS SUCH AS QUALIFICATIONS, EXPERIENCE AND PERFORMANCE AS WELL AS RECRUITMENT AND RETENTION NEEDS. ANNUAL INCENTIVE OPPORTUNITY FOR THE PRESIDENT/CEO, VICE PRESIDENTS AND DIRECTORS ARE POSITIONED ON PAR WITH THE AVERAGE LEVELS PROVIDED TO INDIVIDUALS OCCUPYING COMPARABLE POSITIONS IN THE PEER GROUP. BENEFIT EXPENDITURES ARE POSITIONED ABOVE THE 75TH PERCENTILE AND DESIGNED TO ENCOURAGE RETENTION AND STABILITY OF THE EXECUTIVE TEAM. OUR TOTAL COMPENSATION INCLUDING CASH COMPENSATION AND BENEFITS WILL BE POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE FOR EXPECTED PERFORMANCE. TOTAL COMPENSATION ABOVE THE 75TH PERCENTILE MAY BE ACHIEVED FOR EXCEPTIONAL OR SUPERIOR PERFORMANCE. D. APPROPRIATE PERQUISITES WILL BE PROVIDED BASED ON POSITION LEVEL AND TYPICALLY WILL BE FUNDED BY A PERQ ALLOWANCE. E. A MODERATE SEVERANCE POLICY IS ALSO PROVIDED BASED ON POSITION LEVEL. SEE THE SEVERANCE POLICY FOR FURTHER DETAIL. II. PAY AT RISK INCENTIVE PROGRAM A. YRMC'S ANNUAL INCENTIVE PLAN (OUR "PAY AT RISK" PROGRAM) USES A COMBINATION OF ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE MEASURES. ORGANIZATIONAL MEASURES ALIGNED WITH THE ORGANIZATION'S PILLARS OF PERFORMANCE INCLUDING QUALITY/SAFETY; SERVICE SATISFACTION; PEOPLE, SYSTEMS, PROCESSES; FINANCE AND GROWTH ARE ESTABLISHED ANNUALLY AND APPROVED BY THE BOARD EXECUTIVE COMMITTEE. THE WEIGHTING FOR EACH MEASURE IS ESTABLISHED ANNUALLY AND SLIGHTLY MORE WEIGHT MAY APPLY TO ANY OF THESE FIVE CATEGORIES. TRIGGERS ARE ESTABLISHED TO DEFINE CERTAIN MINIMUM PERFORMANCE LEVELS THAT MUST BE MET BEFORE INCENTIVE AWARDS MAY BE PAID. 1. NET OPERATING MARGIN MUST BE ACHIEVED AT A MINIMUM OF 80% OF BUDGET. 2. ACCREDITATION MUST BE MAINTAINED. B. PERFORMANCE MEASURES ARE TYPICALLY EXPRESSED IN TERMS OF DEFINED OUTCOMES: EACH PERFORMANCE MEASURE INCLUDES THREE LEVELS OF PERFORMANCE THAT CORRESPOND TO THREE LEVELS OF AWARD OPPORTUNITY. 1. A THRESHOLD LEVEL OF PERFORMANCE REPRESENTING "SIGNIFICANT PROGRESS" TOWARD ACHIEVING THE PLANNED PERFORMANCE OBJECTIVE. (TARGET) 2. A STRETCH LEVEL OF PERFORMANCE INDICATING THAT THE PLANNED PERFORMANCE OBJECTIVE HAS BEEN FULLY ACHIEVED. (WINNING) 3. AN OUTSTANDING LEVEL OF PERFORMANCE REPRESENTING RESULTS THAT "CLEARLY EXCEED" THE PLANNED PERFORMANCE OBJECTIVE. (MAXIMUM OR CHAMPION) TARGETS ARE SET AT THE 60TH PERCENTILE OF NATIONAL DATA WHEN AVAILABLE. WINNING LEVEL IS SET AT THE 75TH PERCENTILE AND CHAMPION LEVEL IS THE 90TH PERCENTILE. FOR FINANCIAL MEASURES, WINNING IS SET AT THE BUDGET LEVEL WITH 95% EQUALING TARGET AND 105% EQUALING CHAMPION LEVEL. EACH YEAR, THE CEO RECOMMENDS TO THE COMMITTEE THE OUTCOMES REQUIRED TO ACHIEVE EACH GOAL LEVEL AND PROVIDES SUPPORTING RATIONALE AND DATA FOR THE RECOMMENDATIONS. THE COMMITTEE REVIEWS THE RECOMMENDATIONS, MODIFIES AS APPROPRIATE, AND APPROVES THE FINAL GOALS AND REQUIRED OUTCOMES. PERFORMANCE LEVEL PERCENTAGES ARE SET BASED ON POSITION. DIRECTOR'S WINNING LEVEL EQUALS 10% OF MIDPOINT OF SALARY RANGE WITH A MINIMUM OF 5% AND A MAXIMUM OF 15% WITH 60% WEIGHTING ON ORGANIZATIONAL GOALS, 40% WEIGHTING FOR DIVISION GOALS. C. THE AMOUNT, IF ANY, DUE WILL BE PAID PRIOR TO THE DECEMBER 31 FOLLOWING THE CLOSE OF THE FISCAL YEAR. III. INSURANCE PRODUCTS THE CURRENT AVAILABLE PROGRAMS ARE: 1. LONG-TERM CARE INSURANCE FOR THE EXECUTIVE AND SPOUSE 2. EXECUTIVE DISABILITY COVERAGE (THIS WOULD SUPPLEMENT THE BASIC HOSPITAL PLAN) 3. SURVIVOR LIFE INSURANCE - FOR EXECUTIVES ENROLLING IN THIS BENEFIT, THE HOSPITAL WILL PAY THE EXECUTIVE'S PREMIUM. UNDER APPLICABLE TAX RULES, THE PREMIUM PAYMENTS MADE BY THE HOSPITAL WILL BE TREATED AS A LOAN. THE EXECUTIVE MUST PAY INTEREST ON HOSPITAL PAID PREMIUMS. THE HOSPITAL WILL BE REPAID FROM THE CASH SURRENDER VALUE OF THE POLICY OR THE FACE AMOUNT OF THE POLICY IN THE EVENT OF DEATH. THIS ARRANGEMENT IS DOCUMENTED BY AN AGREEMENT ACCEPTABLE TO THE HOSPITAL. IV. PAID LEAVE TIME CASH OUT REFER TO THE EXECUTIVE PAID LEAVE TIME CASH OUT POLICY FOR DETAILS. THE PURPOSE OF THIS POLICY IS TO ALLOW EXECUTIVES TO CASH OUT A LIMITED AMOUNT OF PLT TO FUND PREMIUMS OR OTHER COSTS FOR INSURANCE OR TO USE THE PROCEEDS IN WHATEVER MANNER THEY WISH. THE EXECUTIVE HAS TO MEET CERTAIN CRITERIA TO QUALIFY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -141,257.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.