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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
THE METROHEALTH FOUNDATION INC
Employer identification number
34-6607695
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
3,970,634
8,298,972
7,559,489
4,354,482
7,066,981
31,250,558
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......
8,130
5,284
316,768
146,405
192,195
668,782
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
876,300
1,049,800
1,366,873
1,374,711
1,651,823
6,319,507
6
Total. Add lines 1 through 5.
4,855,064
9,354,056
9,243,130
5,875,598
8,910,999
38,238,847
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
1,126,131
1,659,113
3,173,753
1,488,725
1,126,131
8,573,853
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.
0
c
Add lines 7a and 7b..
1,126,131
1,659,113
3,173,753
1,488,725
1,126,131
8,573,853
8
Public support (Subtract line 7c from line 6.)
29,664,994
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
4,855,064
9,354,056
9,243,130
5,875,598
8,910,999
38,238,847
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
546,295
530,689
565,457
651,550
925,212
3,219,203
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
849,865
892,127
884,832
796,144
88,201
3,511,169
c
Add lines 10a and 10b.
1,396,160
1,422,816
1,450,289
1,447,694
1,013,413
6,730,372
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
6,251,224
10,776,872
10,693,419
7,323,292
9,924,412
44,969,219
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
65.967 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
63.655 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
14.967 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
16.230 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
THE METROHEALTH FOUNDATION INC
Employer identification number
34-6607695
Return Reference
Explanation
FORM 990, PART VI, LINE 4:
THE FOUNDATION AMENDED ITS CODE OF REGULATIONS IN 2013 TO ADD 2 ADDITIONAL STANDING COMMITTEES: THE GOVERNANCE COMMITTEE AND THE OUTREACH COMMITTEE. THE GOVERNANCE COMMITTEE IS TASKED WITH MONITORING THE FOUNDATION'S ADHERENCE TO ITS MISSION AND POLICIES, ASSISTING IN THE REVIEW OF CONFLICTS OF INTEREST, AND ADVISING THE FULL BOARD ABOUT LEGAL, ORGANIZATIONAL, AND OPERATIONAL ISSUES, AMONG OTHER SIMILAR MATTERS. THE OUTREACH COMMITTEE HAS RESPONSIBILITY FOR STRENGTHENING ALIGNMENT BETWEEN THE FOUNDATION AND THE METROHEATLH SYSTEM'S MISSION AND STRATEGIC DIRECTION, PROVIDING SUPPORT FOR PHILANTHROPIC EFFORTS AND GOALS, AND BUILDING RELATIONSHIPS WITH DONOR GROUPS.
FORM 990, PART VI, LINE 7A:
THE FOUNDATION HAS DIRECTORS THAT ELECT THE GOVERNING BODY.
FORM 990, PART VI, LINE 7B:
THE BOARD HAS SEPARATE COMMITTEES RESPONSIBLE FOR THE FINANCIAL OVERSIGHT (FINANCE COMMITTEE) AND INVESTMENT OF FOUNDATION ASSETS (INVESTMENT COMMITTEE); COMPLIANCE AND FINANCIAL AND FISCAL OVERSIGHT (AUDIT COMMITTEE); BOARD RECRUITMENT (NOMINATING COMMITTEE). THE EXECUTIVE COMMITTEE (MADE UP OF OFFICERS AND ELECTED MEMBERS OF THE BOARD) MAY EXERCISE THE POWERS OF THE BOARD OF DIRECTORS BETWEEN MEETINGS AND SHALL PERFORM SUCH DUTIES AS MAY BE DELEGATED BY THE BOARD OF DIRECTORS. THESE COMMITTEES ARE RESPONSIBLE FOR TAKING APPROPRIATE ACTION ON THE VARIOUS SUBJECTS AND FOR RECOMMENDING AND REPORTING ACTIONS TAKEN TO THE FULL BOARD FOR RATIFICATION IN ALL MATERIAL CASES. IF ACTIONS BEING RECOMMENDED ARE COMPLEX, TYPICALLY THE ACTION IS NOT IMPLEMENTED UNTIL THE FULL BOARD OR EXECUTIVE COMMITTEE OF THE BOARD HAS REVIEWED AND RATIFIED THE DECISIONS.
FORM 990, PART VI, LINE 11A:
THE FOUNDATION BELIEVES THAT DONOR INFORMATION IS CONFIDENTIAL AND HAS CHOSEN TO DISTRIBUTE A COPY OF FORM 990 TO THE BOARD WITH THE DONORS' NAMES AND ADDRESSES REDACTED FROM SCHEDULE B. AS SUCH, WE ARE REQUIRED TO ANSWER "NO" TO THE QUESTION ON LINE 11A OF PART VI SINCE THE BOARD IS NOT RECEIVING A COMPLETE COPY OF FORM 990. HOWEVER, THE BOARD IS RECEIVING ALL PAGES OF FORM 990, INCLUDING THE REDACTED SCHEDULE B, SO THAT IT IS FAMILIAR WITH THIS ANNUAL FILING.
FORM 990, PART VI, LINE 11B:
THE AUDIT COMMITTEE OF THE METROHEALTH FOUNDATION IS CHARGED WITH THE RESPONSIBILITY OF REVIEWING AND APPROVING FORM 990 PRIOR TO ITS SUBMISSION. AN ELECTRONIC COPY AND/OR HARD COPY IS PROVIDED TO THE MEMBERS OF THE COMMITTEE AND REVIEWED IN DEPTH AT A FORMAL MEETING OF THE COMMITTEE MEMBERS. THE AUDIT COMMITTEE APPROVES A MOTION TO SEND THE APPROVED FORM TO THE FULL BOARD OF THE METROHEALTH FOUNDATION. THE APPROVED FORM IS DISTRIBUTED ELECTRONICALLY AND/OR BY HARD COPY TO THE FULL BOARD MEMBERSHIP FOLLOWING THE REVIEW AND APPROVAL OF THE AUDIT COMMITTEE. ANY QUESTIONS OR COMMENTS ARE RESOLVED PRIOR TO THE FILING OF FORM 990. ALL MEMBERS OF THE BOARD OF DIRECTORS ARE OBLIGATED TO REVIEW FORM 990, AND EACH MEMBER DOCUMENTS HIS/HER REVIEW AND APPROVAL ANNUALLY IN WRITING.
FORM 990, PART VI, LINE 12C:
ANNUALLY, BOARD MEMBERS MUST DISCLOSE THEIR BUSINESS AND FAMILY RELATIONSHIPS. THIS INFORMATION IS DOUBLE-CHECKED TO ENSURE THAT THERE ARE NO UNDISCLOSED CONFLICTS IN CARRYING OUT THE BOARD MEMBERS' RESPONSIBILITIES/DUTIES. THE INFORMATION IS UPDATED ANNUALLY BY EACH BOARD MEMBER. THE CHIEF ADMINISTRATIVE OFFICER ALSO MONITORS COMPANIES THAT THE FOUNDATION DOES BUSINESS WITH AND CONFIRMS DISCLOSURE OF BOARD MEMBERS' RELATIONSHIPS WITH THAT BUSINESS. ALSO, TO THE BEST OF OUR KNOWLEDGE, THERE ARE NO KNOWN FORMER OFFICER CONFLICTS.
FORM 990, PART VI, LINE 15:
THE METROHEALTH SYSTEM PAYS THE SALARIES AND BENEFITS OF THE HOSPITAL STAFF WHO ADMINISTER THE METROHEALTH FOUNDATION. THIS IS RECORDED AS AN IN-KIND CONTRIBUTION FROM THE METROHEALTH SYSTEM, ALONG WITH THE CORRESPONDING EXPENSE ON THE FOUNDATION'S FINANCIAL STATEMENTS.
FORM 990, PART VI, LINE 19:
DOCUMENTS ARE PROVIDED UPON REQUEST AND/OR AS REQUIRED THROUGH A GRANT APPLICATION OR STATE REGISTRATION PROCESS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.