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
LAWRENCE MEDICAL ASSOCIATES PC C/O LAWRENCE HOSPITAL CENTER
Employer identification number
26-4076297
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)
LAWRENCE HOSPITAL
131740110
501(C)(3)
Yes
21,266,881
Total
21,266,881
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
LAWRENCE MEDICAL ASSOCIATES PC C/O LAWRENCE HOSPITAL CENTER
Employer identification number
26-4076297
Return Reference
Explanation
FORM 990, PART 1, LINE 1
LAWRENCE MEDICAL ASSOCIATES ("LMA") MISSION IS TO FURTHER LAWRENCE HOSPITAL CENTER'S CHARITABLE PURPOSE OF PROMOTING HEALTH IN THE COMMUNITY.
FORM 990, PART III, LINE 1
LAWRENCE MEDICAL ASSOCIATES ("LMA") MISSION IS TO FURTHER LAWRENCE HOSPITAL CENTER'S CHARITABLE PURPOSE OF PROMOTING HEALTH IN THE COMMUNITY.
FORM 990, PART VI, SECTION A, LINE 6
DR. RIDGE AND DR. ROEDER ARE THE SHAREHOLDERS OF LAWRENCE MEDICAL ASSOCIATES, P.C. THE P.C. IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE SOLE PURPOSE OF SUPPORTING AND FURTHERING THE CHARITABLE PUPORSES OF LAWRENCE HOSPITAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7A
NO ACTION MAY BE TAKEN BY A SHAREHOLDER, OFFICER, OR DIRECTOR, WITHOUT THE WRITTEN CONSENT OF LAWRENCE HOSPITAL CENTER.
FORM 990, PART VI, SECTION A, LINE 7B
SEE EXPLANATION LINE 7A
FORM 990, PART VI, SECTION A, LINE 8A
THE CORPORATION IS A CAPTIVE PC DEVELOPED TO SUPPORT THE NON-PROFIT MISSION OF THE HOSPITAL. THE TWO DIRECTORS ARE EMPLOYEES OF THE HOSPITAL, AS SUCH THEY ARE "CONTROLLED" BY THE HOSPITAL'S CEO AND THE BOARD OF GOVERNORS. THE PRESIDENT OF LAWRENCE MEDICAL ASSOCIATES OR HIS DESIGNEE ATTENDS ALL LAWRENCE HOSPITAL BOARD MEETINGS AND PROVIDES A STATUS REPORT TO THE BOARD. THE MANAGEMENT TEAM OF THE PC MEETS REGULARLY AND AS OFTEN AS NEEDED WITH THE HOSPITALS CEO. THE PRESIDENT OF LMA ALSO IS A MEMBER OF THE HOSPITAL'S FINANCE & AUDIT COMMITTEE, AS WELL AS, ATTEND THE HOSPITAL'S DEPARTMENT HEAD MEETINGS.
FORM 990, PART VI, SECTION A, LINE 8B
SEE LINE 8A EXPLANATION.
FORM 990, PART VI, SECTION B, LINE 11
LAWRENCE MEDICAL ASSOCIATES' FORM 990 WAS REVIEWED IN DETAIL BY THE ORGANIZATION'S DIRECTOR OF FINANCE IN CONJUNCTION WITH ITS TAX PREPARERS, DELOITTE TAX, LLP PRIOR TO SUBMISSION TO THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE OF NYP COMMUNITY SERVICES, INC. NYP COMMUNITY SERVICES, INC. IS THE ACTIVE PARENT OF THE LAWRENCE HOSPITAL CENTER (LAWRENCE MEDICAL ASSOCIATES IS A SUBSIDIARY OF THE LAWRENCE HOSPITAL CENTER) EFFECTIVE JULY 1, 2014. THE 990 IS SENT TO THIS COMMITTEE FOR THEIR REVIEW AND APPROVAL. THE AUDIT AND CORPORATE COMPLIANCE COMMITTEE THEN RECOMMENDS TO THE EXECUTIVE COMMITTEE AND/OR THE FULL BOARD OF TRUSTEES FOR THEIR APPROVAL. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO THE LAWRENCE MEDICAL ASSOCIATES' GOVERNING BODY PRIOR TO FILING. THE 990 IS FILED UPON FINAL APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12C
ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES OF LAWRENCE MEDICAL ASSOCIATES ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE, IN THEIR CAPACITY AS AN EMPLOYEE OF LMA OR AS A BOARD MEMBER TO LMA. THE EXECUTIVE COMMITTEE OF THE BOARD OF GOVERNORS REVIEW THE QUESTIONNAIRES FOR CONFLICTS OF INTEREST AND DECIDE IF THERE ARE ANY SUBSTANTIVE CONFLICTS. IN GENERAL, IF A CONFLICT IS IDENTIFIED, STEPS WILL BE TAKEN TO ENSURE THERE IS NO ACTUAL OR PERCEIVED UNDUE INFLUENCE. SUCH STEPS COULD INCLUDE PROHIBITING THE CONFLICTED PERSON FROM PARTICIPATING IN ANY DECISION REGARDING THE SUBJECT MATTER OR REQUIRING AN AUDIT OF UTILIZATION PATTERNS. IF THE CONFLICTED PERSON IS A BOARD MEMBER OR A KEY EMPLOYEE, ADDITIONAL STEPS MAY BE TAKEN, SUCH AS BEING EXCUSED FROM THE SPECIFIC NEGOTIATION OR FROM PARTICIPATION IN THE COMMITTEE MEETING. THE GOAL IS TO ENSURE TRANSPARENCY IN THE TRANSACTION, THAT THE TRANSACTION IS FAIR AND REASONABLE TO LMA, AND THAT THERE IS NO ADVERSE IMPACT ON PATIENT CARE OR SAFETY. A REVIEW OF THE PROCESS AND ANY FINDINGS ARE REPORTED TO THE BOARD OF GOVERNORS WITH THE CONFLICTED PARTY RECUSED FROM DISCUSSING THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15
LAWRENCE MEDICAL ASSOCIATES UNDERTAKES A THOROUGH AND COMPREHENSIVE PROCESS TO ENSURE THAT THE EXECUTIVE COMPENSATION IT PAYS TO ITS TOP MANAGEMENT OFFICIAL AND ALL OTHER OFFICERS/KEY EMPLOYEES OF THE ORGANIZATION IS REASONABLE. IN RELEVANT PART, THE BOARD OF GOVERNORS HAS ESTABLISHED A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT PERSONS THAT HAVE NO PERSONAL INTEREST IN THE PROPOSED COMPENSATION ARRANGEMENT. THE BOARD OF GOVERNORS ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO ADVISE ON THE APPROPRIATE COMPENSATION LEVELS FOR THE AFOREMENTIONED INDIVIDUALS. THAT COMPENSATION CONSULTANT WILL USE COMPARABILITY OR BENCH-MARKING DATA (BASED ON INDUSTRY SURVEYS) THAT DOCUMENTS THE COMPENSATION OF PERSONS HOLDING SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. ONCE THE COMPENSATION CONSULTANT HAS MADE ITS RECOMMENDATIONS, THE COMPENSATION COMMITTEE MUST APPROVE THE COMPENSATION, WITHOUT INPUT OR VOTING PARTICIPATION BY THE PERSON WHOSE COMPENSATION IS BEING APPROVED OR BY ANY OTHER INDIVIDUAL WITH A CONFLICT OF INTEREST. THE FINAL DETERMINATION IS THEN DOCUMENTED IN COMMITTEE MINUTES. THOSE MINUTES WILL CONTAIN THE TERMS OF THE PROPOSED COMPENSATION, THE DECISIONS OF THOSE INDIVIDUALS WHO VOTED ON THE COMPENSATION, AND THE COMPARABILITY DATA THAT WAS RELIED UPON.
FORM 990, PART VI, SECTION C, LINE 19
LAWRENCE MEDICAL ASSOCIATES MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT THE ADDRESS LISTED ON PAGE 1 OF THIS RETURN. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICTS OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION.
FORM 990, PART VI, SECTION B, LINE 13 & 14
LAWRENCE MEDICAL ASSOCIATES OPERATES UNDER THE WHISTLEBLOWER AND DOCUMENT RETENTION POLICIES OF ITS PARENT ORGANIZATION, LAWRENCE HOSPITAL.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.