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
MEDSTAR INC
Employer identification number
38-2666933
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.") .
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......
15,047,775
15,254,694
16,578,707
18,790,220
21,050,811
86,722,207
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.
15,047,775
15,254,694
16,578,707
18,790,220
21,050,811
86,722,207
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public support (Subtract line 7c from line 6.)
86,722,207
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...
15,047,775
15,254,694
16,578,707
18,790,220
21,050,811
86,722,207
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
57,238
19,396
15,838
168
6,737
99,377
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
57,238
19,396
15,838
168
6,737
99,377
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.)..
15,105,013
15,274,090
16,594,545
18,790,388
21,057,548
86,821,584
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
99.890 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.790 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.110 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.210 %
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
MEDSTAR INC
Employer identification number
38-2666933
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
MEDSTAR IS JOINTLY OWNED BY MCLAREN MACOMB HOSPITAL AND HENRY FORD MACOMB HOSPITAL (50 PERCENT OWNED BY EACH SHAREHOLDER).
FORM 990, PART VI, SECTION A, LINE 7A
FIFTY PERCENT OF THE DIRECTORS SHALL BE ELECTED AT THE ANNUAL MEETING OF THE SHAREHOLDERS BY HOLDERS OF CLASS A COMMON STOCK AND FIFTY PERCENT OF THE DIRECTORS SHALL BE ELECTED AT THE ANNUAL MEETING OF THE SHAREHOLDERS BY HOLDERS OF CLASS B COMMON STOCK. AT LEAST ONE OF THE DIRECTORS ELECTED BY EACH CLASS OF SHAREHOLDER SHALL BE REPRESENTATIVE OF THE COMMUNITY SERVED BY THE CORPORATION AND SUCH DIRECTOR CANNOT BE AN EMPLOYEE OF A SHAREHOLDER.
FORM 990, PART VI, SECTION A, LINE 7B
(A) AMEND, ADOPT, ALTER OR REPEAL THE ARTICLES OF INCORPORATION, CERTIFICATE OF INCORPORATION, OR BYLAWS, OR ANY OTHER ACTION WHICH WOULD CHANGE THE RELATIVE RIGHTS OF THE SHAREHOLDERS OF THE CORPORATION WITH RESPECT TO THOSE RESERVED RESPONSIBILITIES OR WITH RESPECT TO ANY DISTRIBUTIONS FROM THE CORPORATION OR ITS SUBSIDIARIES, INCLUDING THOSE UPON DISSOLUTION. (B) ADOPT ANY STRATEGIC OR ANNUAL OPERATING PLAN (INCLUDING OPERATING OR CAPITAL BUDGETS), OR APPROVAL OF ANY EXPENDITURES ABOVE $25,000 NOT INCLUDED WITHIN AN APPROVED PLAN OR BUDGET, OTHER THAN PURSUANT TO SUBSECTION (F), BELOW. (C) ENCUMBER, OR GRANT A LIEN ON ASSETS OF THE CORPORATION OR ITS SUBSIDIARIES. (D) INCUR, ASSUME OR GUARANTEE ANY LONG-TERM INDEBTEDNESS OR OTHER BORROWINGS, INCLUDING ANY CAPITAL LEASES, OR ANY SHORT-TERM INDEBTEDNESS OTHER THAN SHORT-TERM INDEBTEDNESS NOT IN EXCESS OF $100,000 AND NOT BY ITS TERMS TO BE OUTSTANDING FOR MORE THAN SIXTY (60) DAYS. (E) EXCHANGE, ABANDON OR OTHERWISE DISPOSE OF FIXED ASSETS BY MEANS OF SALE, LEASE OR ANY OTHER VOLUNTARY OR INVOLUNTARY CONVEYANCE OR TRANSFER OF TITLE, WHICH IN THE AGGREGATE IN ANY FISCAL YEAR OF THE CORPORATION AND ITS SUBSIDIARIES EXCEEDS $250,000, EXCEPT AS SPECIFICALLY IDENTIFIED IN A BUDGET APPROVED PURSUANT TO THE PROVISIONS OF SECTION 2.2, PARAGRAPH 2 OF THE CORPORATE BYLAWS. (F) INVEST IN ANY ENTITY, CAPITAL STOCK OR ANY ACQUISITION OF FIXED ASSETS BY MEANS OF PURCHASE, LEASE OR IN ANY OTHER MANNER RESULTING IN EXPENDITURES BY THE CORPORATION AND ITS SUBSIDIARIES WHICH IN THE AGGREGATE IN ANY FISCAL YEAR EXCEEDS $250,000, EXCEPT AS SPECIFICALLY IDENTIFIED IN A BUDGET APPROVED PURSUANT TO THE PROVISIONS OF SECTION 2.2, PARAGRAPH 2 OF THE CORPORATE BYLAWS. (G) AUTHORIZE, TRANSFER OR ISSUE SHARES OF CAPITAL STOCK OF THE CORPORATION OR ANY SUBSIDIARY, OR AUTHORIZE ANY OTHER TYPE OF SECURITY HAVING AN EQUITY INTEREST OR VOTING RIGHTS IN THE CORPORATION OR ANY SUBSIDIARY OR AUTHORIZE ANY CHANGE IN THE MEMBERSHIP OF ANY SUBSIDIARY OR THE CORPORATION. (H) INSTITUTE BY THE CORPORATION OR ANY SUBSIDIARY A VOLUNTARY PROCEEDING SEEKING PROTECTION UNDER FEDERAL OR STATE BANKRUPTCY, INSOLVENCY OR OTHER SIMILAR LAWS. (I) SELL, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF THE CORPORATION OR ANY SUBSIDIARY, OR MERGE OR CONSOLIDATE THE CORPORATION OR ANY SUBSIDIARY WITH ANOTHER ENTITY. (J) DISSOLVE OR REORGANIZE THE CORPORATION OR ANY SUBSIDIARY. (K) EXERCISE ANY POWERS, AUTHORITY OR RESPONSIBILITY REQUIRED BY SECTION 2.2, PARAGRAPH 2 TO BE RESERVED TO THE CORPORATION BY THE ARTICLES OF INCORPORATION, CERTIFICATE OF INCORPORATION OR EQUIVALENT ORGANIZATIONAL DOCUMENTS OF ENTITIES OTHER THAN IN CORPORATE FORM OF ANY SUBSIDIARY.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS REVIEWED BY THE CFO. THE BOARD OF DIRECTORS WAS PROVIDED WITH A FINAL COPY OF THE RETURN FOR THEIR REVIEW AFTER THE RETURN WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
ORGANIZATION POLICY #113 COVERS DISCUSSION OF CONFLICTS WITH EXTERNAL AGENCIES; ALSO POLICIES #104 (COMPLIANCE PLAN) AND #105 (CODE OF CONDUCT) COVER RELATED TOPICS. OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST AS THEY OCCUR, AT LEAST ANNUALLY. THIS IS MONITORED THROUGH DISCUSSIONS WITH BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. INDIVIDUALS WITH A CONFLICT OF INTEREST WOULD BE RESTRICTED FROM SPEAKING OR VOTING ON A POTENTIAL ISSUE. WHEN HIRING NEW EMPLOYEES, THE ORGANIZATION HAS CONTRACTED WITH A 3RD PARTY INVESTIGATIVE AGENCY TO VERIFY EMPLOYMENT INFORMATION TO IDENTIFY ANY POTENTIAL CONFLICTS OF INTEREST. INDIVIDUALS ARE RESTRICTED FROM WORKING AT OR FOR A COMPETITOR IN THE SAME SERVICE AREA/MARKET.
FORM 990, PART VI, SECTION B, LINE 15
THE CEO HAS A WRITTEN EMPLOYMENT CONTRACT, WHICH IS ANNUALLY APPROVED BY THE BOARD OF DIRECTORS. CEO COMPENSATION IS ALSO DETERMINED BY A COMBINATION OF A REVIEW OF PEER FORM 990S (REVIEWED ANNUALLY) AND A COMPENSATION SURVEY (LAST PERFORMED IN 2007). THE REMAINDER OF THE MANAGEMENT TEAM SETS ANNUAL GOALS AND THEY ARE EVALUATED BY THE CEO. ANNUAL REVIEWS ARE COMPLETED ON EACH MEMBER OF THE MANAGEMENT TEAM WITH EVALUATION AND DISCUSSION, MAINTAINED IN THEIR RESPECTIVE PERSONNEL FILES, AS TO THE COMPLETION OF EACH INDIVIDUAL'S ATTAINMENT OF GOALS.
FORM 990, PART VI, SECTION C, LINE 19
MEDSTAR MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:
DISTRIBUTIONS TO MEMBERS -1,000,000.
FORM 990, PART XII, LINE 2C:
THE AUDIT PROCESS HAS NOT CHANGED IN THE CURRENT YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.