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
2012
Open to Public Inspection
Name of the organization
Collis P & Howard Huntington Memorial Hospital Trust
Employer identification number
95-6027688
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 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 monetary support
Yes
No
Yes
No
Yes
No
(A)
PASADENA HOSPITAL ASSOCIATION
951644036
03
Yes
Yes
Yes
3,768,415
Total
3,768,415
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
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
2012
Open to Public Inspection
Name of the organization
Collis P & Howard Huntington Memorial Hospital Trust
Employer identification number
95-6027688
Identifier
Return Reference
Explanation
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
THE TRUST IS A CHARITABLE TRUST, REGISTERED WITH THE REGISTRY OF CHARITABLE TRUSTS PURSUANT TO THE SUPERVISION OF TRUSTEES AND FUNDRAISERS FOR CHARITABLE PURPOSES ACT AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. THE TRUST WAS ESTABLISHED IN 1932 UNDER THE TERMS OF THE WILL OF MR. HENRY HUNTINGTON. THE BEQUEST WAS INVESTED AND LOANED BY THE TRUSTEES FOR THE PURPOSE OF MAKING THE BEST AVAILABLE PROFIT THEREON SO AS TO YIELD AN INCOME FOR THE PERPETUAL MAINTENANCE OF PASADENA HOSPITAL ASSOCIATION. THE TRUST OWNS THE REAL PROPERTY ON WHICH HUNTINGTON MEDICAL HOSPITAL IS LOCATED AND HAS OTHER PROPERTIES AND INVESTMENTS. THE TRUST'S PRIMARY SOURCE OF SUPPORT IS RENTAL INCOME ON PROPERTY AND EQUIPMENT LEASED TO THE HOSPITAL AND THIRD PARTIES AND ITS INVESTMENT EARNINGS. FORM 990, PART III, LINE 4B TRUST CONTRIBUTED $3,768,415 TO PHA TO OFFSET THE UNREIMBURSED COSTS OF THE ASSOCIATION'S MEDICAL EDUCATION PROGRAM. THE CONTRIBUTION BY THE TRUST TO THE ASSOCIATION WAS ACCOUNTED FOR AS TRANSFERS TO AFFILIATES AND A DECREASE IN UNRESTRICTED NET ASSETS. IN ADDITION, TRUST CONTRIBUTED $223,348 TO HMRI IN SUPPORT OF MEDICAL RESEARCH PROGRAMS IN IMMUNOTHERAPY, NEURAL STIMULATION AND OTHER CANCERS.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990
FORM 990, PART VI, LINE 11B
FINANCIAL DATA IS GATHERED FROM MORLIN ASSET MANAGEMENT. THE FINANCIAL DATA IS AUDITED BY AN OUTSIDE ACCOUNTING FIRM. THE AUDITED FINANCIAL DATA IS USED IN PREPARING THE 990 RETURN AND REVIEWED BY THE ASSISTANT SECRETARY/TREASURER PRIOR TO FILING.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST
FORM 990, PART VI, LINE 12C
THE ORGANIZATION REQUESTS FROM EACH TRUSTEE SUBMISSION OF ANNUAL DISCLOSURE FORM (CONFLICT OF INTEREST 2012 CERTIFICATE) NO LATER THAN JAN. 15TH OF EACH YEAR. EACH INTERESTED PERSON MUST MAKE FULL DISCLOSURE TO THE BOARD OF TRUSTEES WHENEVER THE ORGANIZATION IS ENGAGED IN, OR IS PLANNING TO ENGAGE IN, A TRANSACTION, WHICH MAY CREATE A CONFLICT OF INTEREST FOR EACH PERSON. ALL OFFICERS, DIRECTORS AND TRUSTEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE FORM ANNUALLY. THE FORM WILL BE COLLECTED AND REVIEWED. THE COMPLIANCE OFFICER WILL ADDRESS POTENTIAL CONFLICTS, AND REPORT THE RESULTS TO THE BOARD. PERSON'S WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIVERATIONS AND DECISIONS REGARDING THE TRANSACTION OR ARRANGEMENT WITH THE ORGANIZATION. SIGNED COPIES OF CONFLICT OF INTEREST CERTIFICATE 2012 FOR TRUSTEES AND OFFICERS ARE AVAILABLE UPON REQUEST.
DESCRIPTION OF COMPENSATION DETERMINATION PROCESS
FORM 990, PART VI, LINES 15A & 15B
EXECUTIVE COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD OF PASADENA HOSPITAL ASSOCIATION (PHA), AND THE COMMITTEE'S DELIBERATIONS AND DECISIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE MINUTES OF THE MEETING IN WHICH COMPENSATION ARRANGEMENTS WERE DETERMINED. REVIEW & APPROVAL OF COMPENSATION FOR ALL TOP MANAGEMENT OFFICIALS, INCLUDING THE CEO, CFO & VP POSITIONS IS CONDUCTED BY THE COMPENSATION COMMITTEE ANNUALLY, AND THE PERSONS WHO SERVE IN THOSE POSITIONS ARE NOT PRESENT DURING DISCUSSIONS RELATED TO THEIR COMPENSATION. COMPARABLE DATA FOR SIMILAR POSITIONS AND ORGANIZATIONS, PREPARED BY INDEPENDENT CONSULTANTS, IS USED TO ESTABLISH COMPENSATION. REVIEW & APPROVAL FOR THE CEO & VP'S WAS LAST PERFORMED BY THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING HELD ON FEB 27, 2013. PASADENA HOSPITAL ASSOCIATION (PHA) IS RESPONSIBLE FOR THE COMPENSATION REVIEW PROCESS. COLLIS P. & HOWARD HUNTINGTON MEMORIAL HOSPITAL TRUST (CPH) REPORTS THE COMPENSATION AMOUNT PAID BY PHA. EXECUTIVE COMPENSATION IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD OF PASADENA HOSPITAL ASSOCIATION (PHA). REVIEW & APPROVAL FOR THE CEO & VP'S WAS LAST PERFORMED BY THE COMPENSATION COMMITTEE AT ITS ANNUAL MEETING HELD ON FEB 27, 2013. PASADENA HOSPITAL ASSOCIATION (PHA) IS RESPONSIBLE FOR THE COMPENSATION REVIEW PROCESS. COLLIS P. & HOWARD HUNTINGTON MEMORIAL HOSPITAL TRUST (CPH) REPORTS THE COMPENSATION AMOUNT PAID BY PHA.
AVAILABILITY OF GOV DOCS, CONFLICT OF INTEREST POLICY & FINANCIAL STMTS
FORM 990, PART VI, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
AUDIT COMMITTEE
FORM 990, PART XII, LINE 2C
COLLIS P. & HOWARD HUNTINGTON MEMORIAL HOSPITAL TRUST DOES NOT HAVE AN AUDIT COMMITTEE. THE TRUST IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF PASADENA HOSPITAL ASSOCIATION (PHA), WHICH DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE CONSOLIDATED AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
RECONCILIATION OF NET ASSETS
FORM 990, PART XI, LINE 5
$3,882,672 WAS AN INCREASE TO NET ASSETS DUE TO UNREALIZED GAINS FROM UNRESTRICTED FUNDS. $70,065 WAS AN ADDITIONAL INCREASE TO NET ASSETS DUE TO UNREALIZED GAINS FROM ENDOWMENT ROI PER FAS 117-1 WHICH IS RELECTED IN THE TEMPORARY RESTRICTED FUND.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.