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
Maimonides Medical Center
Employer identification number
11-1635081
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.") ....
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
Maimonides Medical Center
Employer identification number
11-1635081
Identifier
Return Reference
Explanation
Form 990 Supplemental Information
FORM 990, PART I, Line 1
OUR COMMITMENT HAS ALWAYS BEEN TO SERVE THE COMMUNITY PROVIDING QUALITY HEALTHCARE SERVICES AND HEALTHCARE EDUCATION REGARDLESS OF RACE, CREED, SEX, NATURAL ORIGIN, AGE, HANDICAP OR ABILITY TO PAY. FORM 990, PART I, LINE 6 - VOLUNTEERS 2012 At Maimonides we are fortunate to have a large corps of dedicated volunteers who enhance the services provided by our staff. There were 1,660 volunteers in 2012 who served 232,689 hours. All volunteer records are kept in a computer database system. Volunteers at Maimonides sign in and out using a touch screen computer. Accordingly the number of volunteers and hours served are tracked by the system. The Department of Volunteer Services works very closely with youth agencies and provides a worksite for various youth employment programs. We coordinate internship programs with business schools and colleges (both undergraduate and graduate programs). This has developed successful relationships with community agencies and organizations. Some of the service areas the volunteers work in are labor coach (doula), postpartum support, companions to patients, feeders, child life, interpreters, greeters, refreshment carts, ladies auxiliary, patient library, chaplaincy, clerical support, patient transport, and other support services.
Form 990 Supplemental Information
FORM 990, PART III, LINE 1
MAIMONIDES MEDICAL CENTER IS DEDICATED TO FOSTERING HEALTHY COMMUNITIES. WE PROVIDE HIGH QUALITY COMPASSIONATE PATIENT CARE AND COMPREHENSIVE COMMUNITY SERVICES. AS A PREMIER ACADEMIC MEDICAL CENTER, WE ARE DEVOTED TO EDUCATING HEALTH CARE PROFESSIONALS, PATIENTS, FAMILIES, EMPLOYEES AND THE COMMUNITIES WE SERVE. WE CONDUCT RESEARCH THAT IMPROVES THE LIVES OF OUR PATIENTS. WE WELCOME ALL PATIENTS OF ALL FAITHS AND AT THE SAME TIME REMAIN UNIQUELY COMMITTED TO SERVING THE SPECIAL HEALTHCARE NEEDS OF THE ORTHODOX JEWISH COMMUNITY, WHOSE RELIGIOUS AND CULTURAL TRADITIONS HELP GUIDE THE PROVISION OF MAIMONIDES SERVICES.
Form 990 Supplemental Information
Form 990, Part III, LINE 4
Maimonides Medical Center, a 711 bed acute care voluntary, not-for profit hospital, offers a wide array of inpatient and outpatient healthcare services. Our commitment has always been to serve the community providing quality healthcare services and healthcare education regardless of race, creed, sex, natural origin, age, handicap or ability to pay. During 2012, the Medical Center provided 45,616 inpatient discharges and 416,514 outpatient visits which included 118,297 emergency room visits. We provided care to persons covered by government programs and the uninsured at payment rates below cost. Our surgeons performed 8,260 inpatient and 12,486 outpatient procedures in a full range of surgical specialties. Our tertiary cardiology and cardiac surgery programs serve all of Brooklyn and are widely recognized in the region for excellence in interventional cardiology. A comprehensive array of cancer services is also provided. Maimonides, a designated regional perinatal center, operates one of the busiest obstetrical services on the East Coast with 8,387 deliveries. A Level 3 Neonatal Intensive Care Unit provides highly specialized care for babies born prematurely or with birth defects. The adult and child psychiatric outpatient programs provide walk-in services for any members of the surrounding communities. Maimonides Medical Center is a 9.39 designated psychiatric receiving hospital. We provide full-time (24 hours/365 days per year) emergency services regardless of ability to pay and operate a 911 paramedic ambulance service under contract with the New York City Fire Department to an 800-block area including all of Boro Park and sections of Flatbush, Bensonhurst and Bay Ridge. The Medical Center supports a program of health promotion and education activities for employees and residents of its surrounding communities, including mammography and colon cancer screenings. The Medical Center is a teaching affiliate of SUNY Downstate Medical Center, St. George's University and Ross University School of Medicine. Maimonides has fully accredited residency-training programs with over 460 interns and residents. The Medical Center's estimated costs for charity care were $45.0 million for 2012. This does not include the service loss of treating the Medicaid population. Additionally, patients who do not qualify for charity care and all uninsured inpatients who do not qualify for Medicaid assistance are billed at the Medical Center's rates. Uncollected balances for these patients are categorized as bad debts. Total uncompensated are as a result of bad debts for all patient services approximated $11.0 million in 2012. For financial reporting purposes, the Medical Center reports as uncompensated care amounts related to care provided for which the patient's payment obligation has not been fully satisfied. Uncompensated care is the sum of the Medical Center's charity care, including free and reduced price medical care, and bad debt expense. During the registration, billing and collection process, a patient's eligibility for charity care is determined. For patients who are determined to be eligible for charity care under the Medical Center's charity care and financial aid policy, care given but not paid for is classified as charity care. The Medical Center amended its charity care and financial aid policy in order to authorize use of additional financial information for uninsured or under-insured patients who have not supplied the requisite information to qualify for charity care. The additional information obtained is used by the Medical Center to determine whether to qualify patients for charity care and/or financial aid in accordance with the Medical Center's policies. For patients who were determined by the Medical Center to have the ability to pay but did not, the uncollected amounts are classified as bad debt expense. Distinguishing between bad debt and charity care is difficult in part because services are often rendered prior to full evaluation of a patient's ability to pay.
Form 990 Supplemental Information
Form 990, Part VI, Governance, Management, and Disclosure
Section A. Governing Body and Management 6. The organization has a member, Maimonides Health Resources, Inc. (MHRI) a not-for-profit, corporation which is its sole corporate member. 7a. MHRI elects the trustees. The board of trustees of Maimonides Medical Center (MMC) is its governing body. 7b. The powers of MHRI are described below: MHRI is a New York not-for-profit corporation. It is the sole member of MMC. MHRI has the following powers pursuant to the MMC bylaws: (1) MHRI elects trustees to the governing body of MMC at the annual meeting. (Vacancies between annual meetings are filled by the board of trustees of MMC, not MHRI). (2) MHRI has the power to amend, modify or repeal the bylaws of MMC. The board of trustees of MMC also has such power. MHRI has the following power under New York's not-for-profit corporation law: (1) Authorization of merger or consolidation requires MHRI's consent. (2) Non-judicial dissolution requires MHRI's consent. (3) MHRI has the power to petition the court for judicial dissolution. (4) The sale or other disposition of all or substantially all of the assets of MMC requires MHRI's consent. (5) The tWO boards are identical. Section B. Policies 11b. a copy of the Form 990 is reviewed by senior executive staff, outside bond COUNSEL and the outside tax preparer who signs off on the return. The reviewed return and attachments are then presented to the President and Audit and Legal Committee of the Board of Trustees to whom the responsibility for reviewing the Form 990 has been delegated for their comments and questions prior to filing. UPON THEIR FINAL REVIEW A complete copy of the Form 990 is PROVIDED to the board prior to filing. 12c. It is the responsibility of all trustees, officers, employees and members of the medical staff to familiarize themselves with the conflicts of interest policy and to comply and ensure compliance of family members where applicable. They are required to disclose in detail any activities or interests which may conflict or appear to conflict with the Medical Center's best interest. The following are required to complete a conflict of interest certificate: (1) trustees and officers of the Board, (2) non-trustee officers, chairmen and division chiefs and members of the purchasing department, (3) employees and members of the medical staff, who are in a position to influence vendor selection, to approve a transaction with a third party or approve the expenditure of funds, and (4) such other employees or members of the medical staff as determined from time to time by the President. Employees and members of the medical staff who violate this policy are subject to disciplinary action up to and including termination or removal from the staff. Members of the Board of Trustees and officers are subject to removal. The Audit and Legal Committee of the Board of Trustees advises the President and the Chairman of the Board concerning specific conflicts of interest referred to it by the Senior Vice President for Legal Affairs and General Counsel. The Committee decides particular matters referred to them for review, and assists in the overall administration and monitoring of the implementation of the policy. The Corporate Compliance Department assists in ensuring compliance with completion of the Certificate by all relevant employees. The SENIOR Vice President for Legal Affairs and General Counsel is responsible for reviewing apparent conflicts of interest and other potentially improper activities as referred by the Corporate Compliance Officer and/or the Audit and Legal Committee. A report of all conflicts of interest is made by the Chairman of the Audit and Legal Committee at least annually to the Board of Trustees. 15. The process for determining compensation includes the following: The Medical Center's compensation committee reviews compensation surveys from independent consultants and data obtained from the Greater New York Hospital ASSOCIATION. Approval for all decisions must be agreed upon by the compensation committee and is then recorded in the minutes of that committee. This process was last done in 2012 for the CEO, COO, CFO and SVP for Legal Affairs/General Counsel/Assistant Secretary. Section C. Disclosure 19. The organization's articles of incorporation may be obtained from the NYS Secretary of State's office. They are also available together with the by-laws upon special request to the Executive Office of Maimonides Medical Center at 4802 Tenth Ave, Admin Bldg, 2nd floor, Brooklyn, NY 11219. The conflict of interest policy is available on the Medical Center's website "maimonidesmed.org" in the vendor information section. The audited financial statements are available upon request to the Medical Center's Executive Office and are posted on the NYS Charitable Bureau website, oag.state.ny.us.
OTHER CHANGES IN FUND BALANCE
FORM 999, PART XI, LINE 9
CHANGE IN EQUITY IN CAPTIVE INSURANCE PROGRAM: $9,615,000
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.