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
Sinai Health System
Employer identification number
36-3166895
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)
Holy Cross Hospital
362170133
Healthcare
Yes
Yes
Yes
0
(B)
Sinai Community Institute
363932824
Healthcare
Yes
Yes
Yes
385,585
(C)
Schwab Rehabilitation
362179802
Healthcare
Yes
Yes
Yes
2,462,485
(D)
Mount Sinai Community Foundation
363305449
Healthcare
Yes
Yes
Yes
1,939,043
(E)
Mount Sinai Hospital
361509000
Healthcare
Yes
Yes
Yes
14,333,245
Total
19,120,358
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:
12000229
Software Version:
2012v2.0
-
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
Sinai Health System
Employer identification number
36-3166895
Identifier
Return Reference
Explanation
Form 990, Part XI, Line 9
Other Changes In Net Assets Or Fund Balances - Other Increases
Restricted Funds = $2610052
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Governing documents, conflict of interest and financial statements are madeavailable upon request and after review by management.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
Sinai Health System has an Executive Compensation Committee to support theorganizational performance of Sinai Health System and its related entities throughthe alignment of executive compensation with system strategies and programs andensure compliance with applicable law. The voting members of the Committee areindependent members of the Board of Directors. The Committee meets twice annually,or more frequently,as circumstances require. The Committee establishes detailedgoals annually for the President and CEO and other executives, and reviewsperformance against these goals on an annual basis. The Committee annually engagesan outside, independent compensation consultant to benchmark the salaries andbenefits of the organization's Assistant Vice Presidents and above, as well as a fewdirectors. Compensation is based on detailed written performance appraisals andexternal market data. In executive session, the Committee reviews the performanceof the President and CEO, each element of compensation, data of compensationprograms in effect for CEOs of comparable organizations, and conducts an annual
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
The 990 was initially prepared by the Finance Staff with multi disciplinary inputfrom Public Affairs, Corporate Integrity and other appropriate staff of theorganization. The 990 was then reviewed by senior finance staff and other members ofSenior Leadership. Ernst & Young,LLP reviewed the return for the organization. Priorto the filing, the 990 was reviewed and discussed with the Executive Committee ofthe Board of Directors. The 990 was also made available to the full Board ofDirectors.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: Support from the Aids Foundation of Chicago allows Sinai to provide Primary and HIVmedical specialty care to 85 uninsured clients in our Adult Infectious Diseaseclinic. Throuh the clinic, Sinai caregivers provide medical and social support casemanagement services to all qualified HIV infected patients. This includes foodvouchers, transportation back and forth to visits, support systems, linkage intocare, and referrals sources.Case manager case load is approximately 170 patients. OTHER PROGRAM SERVICES 5: This program includes the Stand Against Cancer Evaluation Support, Chicago Community Trust Evaluation Grant and Community Health Worker Programs in Chicagos Health Care Access Community Health Network (ACCESS) has implemented the Stand Against Cancer (SAC) program in partnership with the state of Illinois in order to address disparities in breast and cervical cancer outcomes by targeting low income, minority, and uninsured women in the Chicago area. SUHI has previously served as an external evaluation consultant for these efforts. In 2013, SUHI provided the following support and technical assistance:Completed SAC records of abnormal breast and cervical screenings using Sinais medical record system. Built a Microsoft Access database for the SAC abnormal data in order to streamline the data entry and analysis process for ACCESS abnormal cases moving forward.Provided a report detailing how SAC patients access mammography services at Sinai Health System in order to evaluate the capacity of Breast Imaging Services.In May 2010, The Sinai Urban Health Institute (SUHI) began work on an evaluation grant from the Chicago Community Trust (CCT). The purpose of this grant is to provide an evaluation framework for Trust-funded health programs, thereby allowing for critical program review by both grantee organizations and the Trust. This project was conceptualized because many community-based health programs funded by the Trust do not have a structured evaluation plan in place, making it difficult to discern program effectiveness. The primary aim of the Community Health Worker Programs in Chicagos Health Care Institutions project is to clearly delineate Community Health Worker (CHW) effectiveness and best practices in terms of evidence-based science. Information collected in the study will be synthesized and analyzed to: 1.) Create standardized process and outcome evaluation tools for CHW programs; and 2.) Inform the CHW model in health care settings.In 2013 the Sinai Urban Health Institute announces the release of a new report, Best Practices Guidelines for Implementing and Evaluating Community Health Worker Programs in Health Care Settings. This report is the culmination of a two-year project funded by the Lloyd A. Fry Foundation. The Community Health Worker (CHW) Best Practice Guidelines are intended to be a blueprint for health care organizations interested in implementing the CHW model. These practice guidelines were developed to address gaps in the CHW professional literature and assist health care administrators, public health professionals, health care providers, CHWs, and communities in designing and implementing CHW interventions grounded in evidence-based science.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.