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
WESTCHESTER MEDICAL CENTER FOUNDATION INC
Employer identification number
13-4095845
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)
(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 monetary support
Yes
No
Yes
No
Yes
No
Total
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.") ....
1,242,033
916,928
914,315
974,885
1,113,170
5,161,331
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
1,242,033
916,928
914,315
974,885
1,113,170
5,161,331
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)..
323,478
6
Public support. Subtract line 5 from line 4.
4,837,853
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..
1,242,033
916,928
914,315
974,885
1,113,170
5,161,331
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
130,341
43,654
18,085
11,433
6,108
209,621
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
5,370,952
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,174,473
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
90.074 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
82.705 %
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
WESTCHESTER MEDICAL CENTER FOUNDATION INC
Employer identification number
13-4095845
Identifier
Return Reference
Explanation
Description of Classes of Members or Stockholders
Form 990, Part VI, Question 6
THE SOLE MEMBER OF THE FOUNDATION IS WCHCC.
Description of Classes of Persons and the Nature of Their Rights
Form 990, Part VI, Question 7a
THE MEMBER (WCHCC) SHALL ELECT THE TRUSTEES FROM AMONG THOSE PERSONS NOMINATED BY THE NOMINATING COMMITTEE AND APPROVED BY THE BOARD OF TRUSTEES. (FROM ARTICLE III SECTION 3.3 OF THE BY-LAWS).
Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights
Form 990, Part VI, Question 7b
THE MEMBER (WCHCC) HAS THE FOLLOWING RESERVED POWERS (SECTION 2.2 OF THE BY-LAWS: A) APPROVE POLICIES, B) ELECT AND REMOVE TRUSTEES OF THE FOUNDATION, C) AUTHORIZE AMENDMENTS TO CERTIFICATE OF INCORPORATION AND BY-LAWS OF THE FOUNDATION, D) APPROVE AFFILIATION AGREEMENTS, E) APPROVE STRATEGIC AND BUSINESS PLANS, F) APPROVE BUDGETS, G) APPROVE FOUNDATION INVESTMENT POLICIES, H) AUTHORIZE THE FOUNDATION'S PARTICIPATION IN OTHER BUSINESS VENTURES, I) AUTHORIZE THE FOUNDATION'S ORGANIZATION OR FORMATION OF A NEW SUBSIDIARY OR JOINT VENTURE, J) AUTHORIZE THE INCURRENCE OF DEBT, K) APPROVE FOUNDATION'S HUMAN RESOURCE PLANS, L) APPROVE ACCOUNTING POLICIES AND APPOINT OF OUTSIDE AUDITOR, M) AUTHORIZE ANY VOTE BY THE FOUNDATION IN ITS SUBSIDIARIES OR AFFILIATES, AND N) THE POWER TO APPROVE THE FOUNDATION'S DONOR RECOGNITION LEVELS AND NAMING OF ANY PART OF THE MEMBER'S FACILITIES.
Descr Classes of Practices re: Doc of Mtgs & Actions of Each Committee
Form 990, Part VI, Question 8b
GOVERNANCE/NOMINATING COMMITTEE SHALL NOMINATE PERSONS FOR ELECTION AS TRUSTEES OF THE FOUNDATION BY THE MEMBER AND FOR ELECTION OF OFFICERS OF THE FOUNDATION BY THE BOARD OF TRUSTEES. THE COMMITTEE SHALL ALSO PERFORM THE FOLLOWING DUTIES: (ARTICLE IV, SECTION 4.2, PART B): A) REVIEW, ASSESS AND REPORT TO THE BOARD OF TRUSTEES ON THE GOVERNANCE OF THE FOUNDATION, INCLUDING BUT NOT LIMITED TO, MATTERS RELATED TO THE PERFORMANCE, AND COMPOSITION OF THE BOARD OF TRUSTEES AND ITS STANDING AND SPECIAL COMMITTEES. B) ESTABLISH GOALS AND OBJECTIVES FOR THE BOARD OF TRUSTEES FOR EACH YEAR AND CONDUCT A REVIEW AND ASSESSMENT C) REVIEW AND REPORT, AT LEAST ANNUALLY, ON THE ACTUAL FUNCTIONING OF THE BOARD OF TRUSTEES AND D) DEVELOP, IN CONJUNCTION WITH MANAGEMENT, AN ORIENTATION CURRICULUM FOR NEW MEMBERS AND A CONTINUING EDUCATION PROGRAM FOR EXISTING BOARD OF TRUSTEES. THE GOVERNANCE/NOMINATING COMMITTEE SHALL MEET AT LEAST TWICE EACH YEAR AT THE CALL OF THE CHAIR. FINANCE COMMITTEE SHALL REVIEW AND RECOMMEND ANNUAL OPERATING BUDGET TO THE BOARD OF TRUSTEES FOR APPROVAL. THE COMMITTEE CHAIRMAN SHALL REVIEW THE FOUNDATION'S FISCAL STATEMENTS MONTHLY AND REPORT THEM TO THE BOARD. IT SHALL CONSIDER ALL INVESTMENTS AND MATTERS PERTAINING THERETO AND MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES, INCLUDING RECOMMENDATIONS FOR THE ADOPTION AND ANNUAL REVIEW OF AN INVESTENT POLICY. THE FINANCE COMMITTEE MAY MAKE RECOMMENDATIONS TO THE BOARD OF TRUSTEES REGARDING DELEGATION OF THE MANAGEMENT OF FOUNDATION ASSETS TO A DISCRETIONARY REGISTERED INVESTMENT ADVISOR(S). THE FINANCE COMMITTEE SHALL REVIEW, AS APPROPRIATE, THE FINANCIAL IMPLICATIONS AND FEASIBILITY OF ANY RECOMMENDATIONS OF THE VARIOUS COMMITTEES OF BOARD PRIOR TO THEIR PRESENTATION TO THE BOARD. (ARTICLE IV SECTION 4.2 PART C OF THE BY-LAWS). THE FINANCE COMMITTEE SHALL MEET AT LEAST QUARTERLY AT THE CALL OF THE CHAIR OF THE COMMITTEE. THE AUDIT COMMITTEE SHALL PERFORM SUCH DUTIES CONSISTENT WITH THE CUSTOMARY AND USUAL ACTIVITIES OF SUCH COMMITTEES IN ENTITIES OF A SIMILAR SIZE AND CHARACTER, INCLUDING, BUT NOT LIMITED TO THE FOLLOWING (ARTICLE IV SECTION 4.2 PART D OF THE BY-LAWS): A) INQUIRE INTO THE EXISTENCE AND USE OF INTERNAL POLICIES, PROCEDURES AND CONTROLS WITH RESPECT TO BOTH CASH AND NON-CASH ASSETS OF THE FOUNDATION, B) ASSESS WHETHER SIGNIFICANT RISKS OR EXPOSURES EXIST, WHICH COULD RESULT IN LOSS OR LIABILITY TO THE FOUNDATION, C) REVIEW ANY PUBLIC OFFERING STATEMENT, FINANCIAL STATEMENT, TAX RETURN OR OTHER PUBLISHED REPRESENTATION OR PUBLIC FILING OR REPORT. D) RECOMMEND TO THE BOARD OF TRUSTEES THE SELECTION OF A FIRM TO SERVE AS THE FOUNDATION'S EXTERNAL AUDITORS, E) MEET WITH THE EXTERNAL AUDITORS ENGAGED BY THE BOARD OF TRUSTEES AT THE COMMENCEMENT OF THE ANNUAL AUDIT TO DISCUSS THE SCOPE AND CONDUCT OF SUCH AUDIT AND AGAIN AT THE COMPLETION OF THE ANNUAL AUDIT TO DISCUSS THE FINDINGS, RESULTS AND MANAGEMENT LETTER AND F) PERFORM SUCH OTHER FUNCTIONS, POWERS AND DUTIES AS MAY, FROM TIME TO TIME, BE REFERRED TO THE AUDIT COMMITTEE BY THE BOARD OF TRUSTEES. THE AUDIT COMMITTE SHALL MEET AT LEAST QUARTERLY UPON THE CALL OF THE CHAIR THEREOF.
Describe Process used by Management &/or Governing Body to Review 990
Form 990, Part VI, Question 11B
THE 990 IS REVIEWED BY THE FOLLOWING EMPLOYEES OF WCHCC, THE PARENT ENTIY, CONCURRENTLY; THE VP OF FINANCE, THE SVP OF FINANCIAL OPERATIONS, THE CORPORATE COMPLIANCE OFFICER, THE CORPORATION'S INTERNAL GENERAL COUNSEL AND EXECUTIVE VP AND THE OFFICERS WHO SIGN THE FORM 990.
Description of Process to Monitor Transactions for Conflicts of Interest
Form 990, Part VI, Question 12C
IN 2008 A CORPORATE WIDE CONFLICT OF INTEREST POLICY WAS ADOPTED AND INCLUDES ALL RELATED ORGANIZATIONS. THIS POLICY IS MONITORED AND ENFORCED THROUGH REVIEW OF THE DISCLOSURES TO IDENTIFY ANY POTENTIAL OR ACTUAL CONFLICTS. DEPENDING ON THE REVIEW, A COMMITTEE MEETS TO DISCUSS IF THE CONFLICT CAN BE MANAGED OR DOES THE MEMBER NEED TO MAKE A CHOICE IN ORDER TO ELIMINATE THE CONFLICT. THE POLICY IS INCLUDED IN OUR ON-LINE POLICIES AND PROCEDURES SYSTEM CALLED ELLUCID.
EXPL OF HOW ORG MAKES GOV DOCS, COI POLICY & F/S AVAIL TO PUBLIC
Form 990, Part VI, Question 19
ORGANIZATION PROVIDES INFORMATION UPON REQUEST.
EX-OFFICIO MEMBERS OF THE BOARD OF TRUSTEES
Form 990, Part VII
THE FOLLOWING INDIVIDUAL SERVES AS AN EX-OFFICIO MEMBER OF THE BOARD OF TRUSTEES. SINCE THE MEMBER SERVES EX-OFFICIO, WITHOUT VOTE, THE MEMBER IS NOT LISTED AS A TRUSTEE IN PART VII: ALLEN DOZOR, MD
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.