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
Torrance Health Association
Employer identification number
33-0073515
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)
Torrance Memorial Medical Center
951644042
03
Yes
Yes
Yes
9,229,102
Total
9,229,102
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......
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
Torrance Health Association
Employer identification number
33-0073515
Return Reference
Explanation
990, PART I, LINE 1 AND PART III, LINE 1
ORGANIZATION'S MISSION STATEMENT TORRANCE HEALTH ASSOCIATION SUPPORTS TORRANCE MEMORIAL MEDICAL CENTER AND ITS CHARITABLE MISSION OF PROVIDING HEALTH SERVICES TO THE COMMUNITY OF TORRANCE, CA AND SURROUNDING AREAS.
FORM 990 PART III, LINE 4A
Program Service Accomplishments Health Education provides the satellite office space for classes including childbirth, CPR, first aid, etc. and community service programs that deal with health care screening; wellness/lifestyle information management of chronic disease, and support of numerous agencies providing health care and housing services for vulnerable populations. Breast Diagnostic Center provides space for the hospital's (TMMC) satellite breast diagnostic services. The satellite centers help make mammograms more accessible and available to women in the community.On behalf of Torrance Memorial Medical Center (TMMC), Torrance Health Association (THA) makes strategic financial and legal decisions, identifies available resources, and provides direction and guidance in order to maximize resources available for use in delivering cost-effective health care to the community.
FORM 990 PART III, LINE 4B
Torrance Memorial Physician Network (TMPN) is a primary care and multi specialty network of physicians and health professionals focused on caring for people in the community. Their focus is on family and internal medicine, but also offers sub-specialty medical services such as endocrinology, rheumatology and diabetes care. TMPN provides guidance on what medical screening is needed and when to have them. The partnership with Torrnace Memorial Health Systems brings valuable resources that enables them to provide an higher level of coordinated, compassionate and highly personal care. TMPN emphasizes communication and collaborative approach to integrated care for the whole patient.
FORM 990 PART III, LINE 4C
Torrance Hospital IPA (THIPA) is a multi-specialty physician network that offers over 150 primary care doctors and 250 specialists to its members. THIPA gives easy access to the South Bay's leading doctors, specialist and healthcare practitioners and has been serving the South Bay community for over 29 years. They provide personalized, cutting-edge medical care to its members. The varied educational and experiential backgrounds of the THIPA leadership, ranging from medicine over public health to management, allow a broad and comprehensive approach to the medical care of the members.
FORM 990, PART I, QUESTION 6
VOLUNTEERS HEALTH RESOURCES CENTER AND HEALTH EDUCATION USES VOLUNTEERS IN VARIOUS AREAS. THEY ARE USED TO GREET PATIENTS AND VISITORS IN THE HEALTHLINKS DEPARTMENT. THEY ALSO HELP WITH VARIOUS LIGHT OFFICE DUTIES.
FORM 990, PART VI, QUESTION 11A
DESCRIBE THE PROCESS TO REVIEW FORM 990 THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT ALONG WITH OUR TAX ADVISORS. THE FORM 990 WAS REVIEWED BY SENIOR MANAGEMENT BEFORE BEING PRESENTED TO THE BOARD OF TRUSTEES. OUR TAX ADVISORS DISCUSSED AND EDUCATED THE TRUSTEES ON THE FORM 990. AFTER THE FINAL REVIEW IS COMPLETE, AN OFFICER OF THE ORGANIZATION SIGNS THE FORM 990.
FORM 990, PART VI, LINE 12C
DESCRIPTION OF PROCESS USED TO MONITOR FOR CONFLICTS OF INTEREST TORRANCE HEALTH ASSOCIATION'S ("THE ASSOCIATION") MONITORING, REVIEW AND ENFORCEMENT OF ITS CONFLICT OF INTEREST POLICY RESTS WITH ITS NOMINATING COMMITTEE. ANNUALLY, THE ASSOCIATION SENDS ALL TRUSTEES, OFFICERS, EXECUTIVES, AND MANAGERIAL EMPLOYEES A COPY OF THE ASSOCIATION'S CONFLICT OF INTEREST POLICY AND CONFLICT OF INTEREST QUESTIONNAIRE. ALL TRUSTEES, OFFICERS, EXECUTIVES AND MANAGERIAL EMPLOYEES ARE REQUIRED TO SIGN A STATEMENT THAT THEY HAVE RECEIVED AND READ THE CONFLICT OF INTEREST POLICY. ADDITIONALLY, THEY MUST ALSO COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE. THE QUESTIONNAIRE INQUIRES AS TO ALL INDIVIDUALS CONCERNED WITH CONDUCTING, TRANSACTING OR APPROVING THE BUSINESS MATTERS OF THE ASSOCIATION. ONCE THE CONFLICT OF INTEREST QUESTIONNAIRES HAVE BEEN RECEIVED BACK FROM THE OFFICERS, TRUSTEES AND EXECUTIVES, THEY ARE REVIEWED AND SUMMARIZED BY THE NOMINATING COMMITTEE FOR PRESENTATION TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE REPORTS ANY CONFLICTS TO THE BOARD OF TRUSTEES WITH THEIR RECOMMENDATION AS TO THE NATURE OF THE CONFLICT THAT MAY IMPEDE THE INDEPENDENCE OF THE BOARD MEMBER. IF AN OFFICER, TRUSTEE, OR EXECUTIVE IS FOUND TO HAVE A CONFLICT, THERE IS A PROCESS IN PLACE TO PROHIBIT THIS INDIVIDUAL FROM PARTICIPATING IN THE DELIBERATIONS AND DECISIONS IN THE TRANSACTION. MANAGERIAL EMPLOYEE'S CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY THE AREA VICE PRESIDENT. CONFLICTS ARE NOTED AND FORWARDED TO HUMAN RESOURCES FOR SUMMARIZATION. IF MATERIAL CONFLICTS EXIST, THEY ARE FORWARDED TO THE CEO, WHO TOGETHER WITH THE AREA VICE PRESIDENT, RESOLVE THE ISSUE WITH THE MANAGER.
FORM 990, PART VI, QUESTION 15A
PROCESS FOR DETERMINING COMPENSATION PROCESS FOR DETERMINING COMPENSATION OF OFFICERS AND KEY EMPLOYEES FOR THE TAX YEAR 2013, THA'S RELATED ORGANIZATION, TORRANCE MEMORIAL MEDICAL CENTER'S (TMMC) BOARD OF TRUSTEES HAS ESTABLISHED A COMPENSATION SUBCOMMITTEE (A SUBCOMMITTEE OF THE EXECUTIVE COMMITTEE) TO REVIEW AND RECOMMEND THE COMPENSATION AND BENEFITS OF THE CEO AND KEY LEADERSHIP POSITIONS OF THE CORPORATION. THE COMPENSATION SUBCOMMITTEE IS RESPONSIBLE FOR PERIODIC EVALUATION OF THE PERFORMANCE OF THE PRESIDENT AND CONFERS WITH THE PRESIDENT CONCERNING THE PRESIDENT'S EVALUATION OF THE OTHER EXECUTIVE OFFICERS. THE COMPENSATION SUBCOMMITTEE IS AN ENTIRELY INDEPENDENT COMMITTEE WITH RESPECT TO THE TRANSACTION. THE COMPENSATION SUBCOMMITTEE RETAINS AN OUTSIDE COMPENSATION CONSULTANT TO CONDUCT PERIODIC REVIEWS OF THE TOTAL COMPENSATION OF THE KEY LEADERSHIP POSITIONS (BASE COMPENSATION, OTHER INCENTIVES/BONUSES, AND BENEFITS). THE CONSULTANTS ARE INDEPENDENT AND ARE QUALIFIED TO ASSESS EXECUTIVE COMPENSATION VALUATIONS. IN REVIEWING AND ESTABLISHING COMPENSATION RECOMMENDATIONS, THE CONSULTANTS COLLECT BACKGROUND INFORMATION ON THE SIZE AND COMPLEXITY OF OPERATIONS AND THE SCOPE OF THE KEY LEADER'S RESPONSIBILITIES. THEY REVIEW VARIOUS SURVEYS, 990'S OF OTHER COMPARABLE OUTSIDE HEALTH CARE ORGANIZATIONS, AND MATCH SURVEYS BASED ON THE ABOVE CRITERIA, TAKING BOTH LOCAL AS WELL AS NATIONAL MARKET DATA INTO CONSIDERATION. AFTER THE DATA HAS BEEN REVIEWED AND ANALYZED THE CONSULTANT PRESENTS THE REPORT TO THE COMPENSATION SUBCOMMITTEE WITH HIS/HER FINDINGS AND RECOMMENDATIONS. THE COMPENSATION SUBCOMMITTEE REVIEWS THE REPORT AND FINDINGS WITH THE CONSULTANT AND RECOMMENDS TO THE EXECUTIVE COMMITTEE ANY CHANGES TO THE KEY LEADERSHIP COMPENSATION AND BENEFIT PACKAGES. THE EXECUTIVE COMMITTEE MAY APPROVE THOSE RECOMMENDATIONS AND REPORT ANY CHANGES TO THE FULL BOARD OF TRUSTEES. THE COMPENSATION SUBCOMMITTEE MAINTAINS WRITTEN RECORDS WHICH INCLUDE THE (1) TERMS OF THE ARRANGEMENT WITH THE CEO AND KEY LEADERSHIP INDIVIDUALS (INCLUDING THE DATE THE ARRANGEMENT WAS APPROVED); (2) A LIST OF MEMBERS PRESENT DURING THE DEBATE ON THE TRANSACTION (AND HOW THE MEMBERS VOTED WHEN IT WAS APPROVED); AND (3) A DESCRIPTION OF THE COMPARABLE DATA RELIED ON BY THE COMMITTEE. KEY DELIBERATIONS OF THE COMPENSATION SUBCOMMITTEE ARE ALSO DOCUMENTED IN MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING.
FORM 990, PART VI, QUESTION 16B
JOINT VENTURE ARRANGEMENTS TORRANCE HEALTH ASSOCIATION HAS TAKEN PART IN ONLY THREE JOINT VENTURES TO DATE. MANAGEMENT TOOK ADEQUATE MEASURES TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS AND THE AGREEMENTS WERE REVIEWED BY LEGAL COUNSEL FOR ADHERENCE TO ALL APPLICABLE LAWS AND REGULATIONS.
FORM 990, PART VI, QUESTION 19
AVAILABILITY OF DOCUMENTS TO THE PUBLIC FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTIONS. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THE ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE SECRETARY OF STATE.
990, PART VII
TORRANCE HEALTH ASSOCIATION PAYS COMPENSATION TO HUGO HOOL, MD, A BOARD MEMBER, FOR PHYSICIAN SERVICES RENDERED TO TORRANCE MEMORIAL PHYSICIANS NETWORK.
990, PART IX, LINE 11G
OTHER FEES FOR SERVICES Non Clinical Registry 29,987 Prof Fees - Other 326,526 Prof Fees - Transcriptions 9,853 PS Medical 5,530 Total Laboratory 41,315 Total X-Ray 66,582 PS Repairs & Maint 359,843 PS Repairs & Maint - Clinical 33,694 PS Repairs & Maint - Ancillary 15,268 PS Other 566,381 Contract Payments 245,696 Equipment Rental/Lease 284,660 THIPA Capitation Expenses 24,660,355 THIPA Direct Medical Cost Expenses 31,327,091 THIPA Quality Incentive Expenses 1,134,624 Other 605,289
PART XI, LINE 9
OTHER CHANGES IN NET ASSETS OR FUND BALANCES TAX LOSS PARTNERSHIP INVESTMENTS 63,708 BOOK LOSS ON PARTNERSHIP INVESTMENTS (86,567) INTEREST ON PARTNERSHIP INVESTMENT (1,883) EQUITY TRANSFER 4,185,260 ----------- TOTAL 4,160,518
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.