Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
JACKSON MEMORIAL FOUNDATION INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1501 NW NORTH RIVER DRIVE
 
Room/suite
City or town, state or country, and ZIP + 4
MIAMI, FL33125
D Employer identification number

65-0077727
E Telephone number

G Gross receipts $ 6,917,510
F Name and address of principal officer:
JAMES CHAMPION
1501 NW NORTH RIVER DRIVE
MIAMI,FL33125
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.JMF.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1987
M State of legal domicile: FL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: JACKSON MEMORIAL FOUNDATION OPERATES EXCLUSIVELY TO SUPPORT JACKSON HEALTH SYSTEM A CODE SEC 170(B)(1)(A)(III)ORGANIZATION AND THE ONLY PUBLIC HOSPITAL IN MIAMI-DADE COUNTY, FLORIDA. THE MISSION OF JMF IS TO CONDUCT TRADITIONAL PHILANTHROPIC ACTIVITIES AND INDEPENDENTLY CREATE AND IMPLEMENT OTHER VISIONARY INITIATIVES THAT FINANCIALLY ASSIST JACKSON HEALTH SYSTEM IN ADVANCING ITS STATUS AS A WORLD-CLASS MEDICAL CENTER.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 33
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 33
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 20
6 Total number of volunteers (estimate if necessary) ............. 6 43
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 6,379,638 4,528,760
9 Program service revenue (Part VIII, line 2g) .........   0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 338,389 624,556
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -317,495 -345,719
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 6,400,532 4,807,597
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,647,931 5,115,364
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 1,455,823 1,486,748
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,049,237    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,427,287 590,828
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 5,531,041 7,192,940
19 Revenue less expenses. Subtract line 18 from line 12....... 869,491 -2,385,343
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 14,381,693 11,864,404
21 Total liabilities (Part X, line 26)............. 543,798 589,722
22 Net assets or fund balances. Subtract line 21 from line 20..... 13,837,895 11,274,682
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: JACKSON MEMORIAL FOUNDATION OPERATES EXCLUSIVELY TO SUPPORT JACKSON HEALTH SYSTEM A CODE SEC 170(B)(1)(A)(III)ORGANIZATION AND THE ONLY PUBLIC HOSPITAL IN MIAMI-DADE COUNTY, FLORIDA. THE MISSION OF JMF IS TO CONDUCT TRADITIONAL PHILANTHROPIC ACTIVITIES AND INDEPENDENTLY CREATE AND IMPLEMENT OTHER VISIONARY INITIATIVES THAT FINANCIALLY ASSIST JACKSON HEALTH SYSTEM IN ADVANCING ITS STATUS AS A WORLD-CLASS MEDICAL CENTER.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 3,215,770 including grants of $ 3,207,724 ) (Revenue $   )
THE FOUNDATION OPERATES EXCLUSIVELY FOR THE PURPOSE OF ACQUIRING FUNDS AND OTHER APPROPRIATE ASSETS FROM THE PRIVATE AND PUBLIC SECTOR TO IMPROVE THE DELIVERY OF HEALTHCARE AT JACKSON HEALTH SYSTEM; SUPPORT TEACHING AND TRAINING PROGRAMS IN HEALTHCARE; SUPPORT MEDICAL AND SURGICAL TREATMENTS AT THE HOSPITAL; SUPPORT INSTRUCTION AND TRAINING OF PERSONNEL; SUPPORT THE HOSPITAL'S CAPITAL IMPROVEMENT PROJECTS WITHIN THE MEDICAL CAMPUS.
4b (Code:   ) (Expenses $ 2,278,523 including grants of $ 1,907,640 ) (Revenue $   )
INTERNATIONAL KIDS FUND (IKF) IS A PHILANTHROPIC PROGRAM THAT HELPS CRITICALLY ILL CHILDREN PRIMARILY FROM LATIN AMERICA AND THE CARIBBEAN GAIN IMMEDIATE ACCESS TO ESSENTIAL MEDICAL TREATMENTS THAT ARE UNAVAILABLE IN THEIR RESPECTIVE COUNTRIES. IKF SUCCESSFULLY RAISES FUNDS AND ADMINISTERS PROACTIVE ASSISTANCE FOR FOREIGN CHILDREN WITH URGENT HEALTH CARE NEEDS TO RECEIVE EXPERT ATTENTION AT THE HOLTZ CHILDREN'S HOSPITAL IN THE JACKSON HEALTH SYSTEM.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet5,494,293
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions).... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
6
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
20
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
No
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
33
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
33
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
Yes
 
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
FL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletZULLY FORD FIN DIRECTOR1501 NW NORTH RIVER DRIVEMIAMIFL33125 (305) 585-1731
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) ALVAREZ CESAR........................................................................
VICE-CHAIR
 4.00
.......................   		X   X       0 0 0
(2) BEATTY ROBERT G ESQ........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(3) BASTIAN BUNNY........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(4) BATCHELOR SANDY........................................................................
SECRETARY
 4.00
.......................   		X   X       0 0 0
(5) BERKOWITZ YOLANDA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(6) BILZIN BRIAN........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(7) QUINTERO NORMA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(8) CARR CINDY........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(9) CARRICARTE MICHAEL........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(10) CORDOBA GOOD MARIA C........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(11) SHARPTON DARRYL K........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(12) COULSON DAVID ESQ........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(13) DIMARE JR PAUL J........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(14) GREENE KIM........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(15) LIPTON JANICE........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(16) LOPEZ-CANTERA CARLOS........................................................................
CHAIRMAN
 4.00
.......................   		X   X       0 0 0
(17) MCENANY PATRICK J........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MOISE RUDOLPH MD
 
TREASURER
 4.00
.......................   		X   X       0 0 0
(19) NESTOR CASTELLANO BRENDA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(20) POLIAKOFF STEVEN R........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(21) PRESS SHIRLEY MD........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(22) RILEY CHRIS........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(23) MIGOYA CARLOS........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(24) VIYELLA CANDIDO........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(25) FORTUN SILVIA........................................................................
GUANGELCHAIR
 2.00
.......................   		X           0 0 0
(26) WALLACE PATRICIA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(27) CONESE EUGENE P........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(28) DIMOND ALAN T........................................................................
PASTCHAIRMAN
 4.00
.......................   		X           0 0 0
(29) HOLTZ ABEL........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(30) MARTINEZ MARIANA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(31) MITCHELL JOANNE........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(32) RODRIGUEZ MANNY J........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(33) MAGGIE VILLACAMPA........................................................................
DIRECTOR
 2.00
.......................   		X           0 0 0
(34) THOMAS SCHRAMM........................................................................
PRESIDENT &
 40.00
.......................   		    X       94,516 0 6,533
(35) CHAMPION JAMES A........................................................................
INTR PRESIDE
 20.00
.......................   		    X       0 0 0
(36) BENDER JOAN........................................................................
VP OF DEVELO
 40.00
.......................   		      X     180,378 0 21,000
(37) RODRIGUEZ ROLANDO........................................................................
FORMER PRES
 0.00
.......................   		          X 82,337 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 357,231   27,533
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet3
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
WOW FACTOR800 DOUGLAS RD STE 105CORAL GABLESFL33134 EVENT PRODUCTIO 177,887
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 237,700
b Membership dues....1b  
c Fundraising events....1c 1,026,223
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		3,264,837
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 4,528,760
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet  
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 103,937     103,937
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,143,513  
b Less: cost or other basis and sales expenses 1,622,894  
c Gain or (loss) 520,619  
d Net gain or (loss)..........MediumBullet 520,619 520,619    
8a Gross income from fundraising events (not including
$ 1,026,223
of contributions reported on line 1c). See Part IV, line 18 ..
a 141,300
b Less: direct expenses ...b 487,019
c Net income or (loss) from fundraising events..MediumBullet -345,719    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 4,807,597 520,619   103,937
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 5,115,364 5,115,364
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 225,910   90,364 135,546
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 961,715 192,175 307,816 461,724
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 59,609 6,564 21,218 31,827
9 Other employee benefits ....... 149,542 45,094 41,779 62,669
10 Payroll taxes ........... 89,972 12,436 31,014 46,522
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ........... 83,281 5,225 46,834 31,222
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 42,432 17,579 14,912 9,941
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 22,781 410 11,645 10,726
12 Advertising and promotion .... 197,739 48,247   149,492
13 Office expenses ....... 35,145 7,966 10,618 16,561
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 106,638 30,014 32,155 44,469
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 27,151   16,290 10,861
23 Insurance .............. 22,085   8,834 13,251
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a TELEPHONE 20,040 6,986 5,222 7,832
b PARKING - VIP & STAFF 12,237 3,229 3,603 5,405
c MISCELLANEOUS 11,105   4,442 6,663
d AUTO EXPENSE 7,260 3,004 1,490 2,766
e All other expenses 2,934   1,174 1,760
25 Total functional expenses. Add lines 1 through 24e 7,192,940 5,494,293 649,410 1,049,237
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 327,328 1 856,629
2 Savings and temporary cash investments ......... 4,288,593 2 4,061,295
3 Pledges and grants receivable, net ........... 5,511,216 3 3,585,185
4 Accounts receivable, net .............   4  
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8 41,335
9 Prepaid expenses and deferred charges .......... 35,096 9 26,562
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 422,040
b Less: accumulated depreciation ..... 10b 378,249 61,641 10c 43,791
11 Investments—publicly traded securities .......... 4,027,819 11 3,089,617
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 130,000 15 159,990
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 14,381,693 16 11,864,404
Liabilities 17 Accounts payable and accrued expenses ......... 543,798 17 589,722
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................   25  
26 Total liabilities. Add lines 17 through 25......... 543,798 26 589,722
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 1,652,122 27 294,983
28 Temporarily restricted net assets ........... 12,185,773 28 10,979,699
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 13,837,895 33 11,274,682
34 Total liabilities and net assets/fund balances ........ 14,381,693 34 11,864,404
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
4,807,597
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
7,192,940
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-2,385,343
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
13,837,895
5
Net unrealized gains (losses) on investments ...............
5
-177,870
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
11,274,682
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
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
f
g
(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) 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) right arrow (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.") .... 8,425,036 8,913,240 7,145,971 6,379,638 4,528,760 35,392,645
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 8,425,036 8,913,240 7,145,971 6,379,638 4,528,760 35,392,645
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)..           2,718,562
6 Public support. Subtract line 5 from line 4.           32,674,083
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 8,425,036 8,913,240 7,145,971 6,379,638 4,528,760 35,392,645
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 246,651 129,258 91,340 99,786 103,937 670,972
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).           36,063,617
12
12
141,300
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
90.600 %
15
15
91.890 %
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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) right arrow (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
JACKSON MEMORIAL FOUNDATION INC
  		Employer identification number

65-0077727
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
JACKSON MEMORIAL FOUNDATION INC
  		Employer identification number

65-0077727
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
JACKSON MEMORIAL FOUNDATION INC
  		Employer identification number

65-0077727
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 500,000 1,714,371 1,690,967 1,585,819  
b Contributions ........          
c Net investment earnings, gains, and losses     23,404 105,148  
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		  1,214,371      
f Administrative expenses ....          
g End of year balance ...... 500,000 500,000 1,714,371 1,690,967  
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet100.000 %
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   169,897 140,530 29,367
d Equipment ................   125,656 112,239 13,417
e Other .................   126,487 125,480 1,007
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 43,791
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 5,074,312
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -177,870
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e -177,870
3 Subtract line 2e from line 1..................... 3 5,252,182
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 42,430
b Other (Describe in Part XIII.) ........... 4b -487,015
c Add lines 4a and 4b....................... 4c -444,585
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 4,807,597
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 7,637,525
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 487,015
e Add lines 2a through 2d...................... 2e 487,015
3 Subtract line 2e from line 1..................... 3 7,150,510
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 42,430
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c 42,430
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 7,192,940
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 4B EVENT EXPENSES REPORTED UNDER FUNDRAISING EXPENSES -487,015 IN AUDIT BUT NETTED AGAINS EVENT REVENUE 0
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D EVENT EXPENSES REPORTED UNDER FUNDRAISING EXPENSES IN AUDI 487,015 BOOK / TAX DEPRECIATION DIFFERENCE 430
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Part I
General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
CARIBBEAN     FUNDRAISING    
LATIN AMERICA     FUNDRAISING    
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....      
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2012
Schedule F (Form 990) 2012
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
ACTIVITIES PER REGION SCHEDULE F, PAGE 1, PART I, LINE 3 CARIBBEAN 0 0 LATIN AMERICA 0 0
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2012
Additional Data


Software ID:  
Software Version:  



SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
FL
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

ANNUAL GALA
(event type) 		(b) Event #2

ANNUAL GUA LUNC
(event type) 		(c) Other events

1
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 977,208 125,138 65,177 1,167,523
2 Less: Contributions . . 867,208 107,138 51,877 1,026,223
3 Gross income (line 1
minus line 2) . . . 		110,000 18,000 13,300 141,300
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages .        
8 Entertainment . . .        
9 Other direct expenses . 396,560 43,152 47,307 487,019
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 487,019
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow -345,719
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number
65-0077727
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) JACKSON HEALTH SYSTEM & UM MEDICAL
1611 NW 12TH AVE
MIAMI,FL33136 		59-1713947 3 2,427,283       FUND HOSP. PROJECTS
(2) JACKSON HEALTH SYSTEM & UM MEDICAL
1611 NW 12TH AVE
MIAMI,FL33136 		59-1713947 3   780,441 COST EQUIPMENT PD ON BEHALF OF JMH
(3) JACKSON HEALTH SYSTEM & UM MEDICAL
1611 NW 12TH AVE
MIAMI,FL33136 		59-1713947 3 1,202,589       INTERNATIONAL KIDS F
(4) JACKSON HEALTH SYSTEM & UM MEDICAL
1611 NW 12TH AVE
MIAMI,FL33136 		59-1713947 3   705,051 COST EXPENSES PAID INTERNATIONAL KIDS F
















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)BENDER JOANVP OF DEVELOPMENT (i)
(ii)		 180,378
  		 
  		 
  		21,000
  		 
  		201,378
  		 
 
(2)RODRIGUEZ ROLANDOFORMER PRES & CEO (i)
(ii)		 82,337
  		 
  		 
  		 
  		 
  		82,337
  		 
 
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 RODRIGUEZ ROLANDO 82,337 0 0
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
JACKSON MEMORIAL FOUNDATION INC
 
Employer identification number

65-0077727
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION JACKSON MEMORIAL FOUNDATION OPERATES EXCLUSIVELY TO SUPPORT JACKSON HEALTH SYSTEM A CODE SEC 170(B)(1)(A)(III)ORGANIZATION AND THE ONLY PUBLIC HOSPITAL IN MIAMI-DADE COUNTY, FLORIDA. THE MISSION OF JMF IS TO CONDUCT TRADITIONAL PHILANTHROPIC ACTIVITIES AND INDEPENDENTLY CREATE AND IMPLEMENT OTHER VISIONARY INITIATIVES THAT FINANCIALLY ASSIST JACKSON HEALTH SYSTEM IN ADVANCING ITS STATUS AS A WORLD-CLASS MEDICAL CENTER.
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS FORM 990, PAGE 1, PART I, LINE 6 THE ORGANIZATION ESTIMATES THE NUMBER OF VOLUNTEERS AS FOLLOWS: BOARD MEMBERS SERVING THE ORGANIZATION ON A VOLUNTEER BASIS = 33 INTERNATIONAL KIDS FUND VOLUNTEER BOARD MEMBERS = 6 VOLUNTEERS WHO ASSIST AT FUNDRAISING EVENTS AND PARTICIPATE IN EVENT PLANNING COMMITTEES THROUGHOUT THE YEAR = 4
ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE ORGANIZATION SHALL HAVE UP TO 45 VOTING DIRECTORS AND ONE NON-VOTING DIRECTOR. THE DIRECTORS SHALL BE COMPOSED OF THE FOLLOWING: (A) THE CHAIR, VICE-CHAIR, SECRETARY AND TREASURER OF THE CORPORATION. (B) THE IMMEDIATE PAST CHAIR OF THE CORPORATION. (C) UP TO 30 ELECTED DIRECTORS. (D) THE CHAIR OF THE GOLDEN ANGEL SOCIETY (E) THE PRESIDENT AND CEO OF THE JACKSON HEALTH SYSTEM (F) THE CHAIR OF THE MIAMI-DADE COUNTY PUBLIC HEALTH TRUST (G) THE CHAIRS OF THE AUXILIARY GROUPS (H) THE PRESIDENT AND CEO OF THE FOUNDATION WHO SHALL SERVE WITH NO VOTE. ELECTION AND TERM OF OFFICE: THE MEMBERS OF THE BOARD OF DIRECTORS WHO ARE ELECTED AS DIRECTORS SHALL BE DIVIDED INTO THREE GROUPS SO AS TO ROTATE ONE THIRD OF THE BOARD EACH YEAR. THE NUMBER OF DIRECTORS IN EACH GROUP SHALL BE AS NEARLY EQUAL AS POSSIBLE. AT EACH ANNUAL MEETING OF THE BOARD, THE SUCCESSORS OF THE ELECTED DIRECTORS WHOSE TERMS ARE EXPIRING SHALL BE ELECTED FOR A THREE YEAR TERM EXPIRING AT THE THIRD SUCCESSIVE ANNUAL MEETING OF THE BOARD. IF THE NUMBER OF ELECTED DIRECTORS IS CHANGED, ANY INCREASE OR DECREASE SHALL BE APPORTIONED AMONG THE CLASSES SO AS TO MAINTAIN THE NUMBER OF DIRECTORS IN EACH GROUP AS NEARLY EQUAL AS POSSIBLE, AND ANY ADDITIONAL DIRECTORS OF ANY GROUP ELECTED TO FILL A VACANCY RESULTING FROM AN INCREASE IN SUCH GROUP SHALL HOLD OFFICE FOR A TERM THAT SHALL COINCIDE WITH THE REMAINING TERM OF THAT GROUP, BUT IN NO CASE SHALL A DECREASE IN THE NUMBER OF DIRECTORS SHORTEN THE TERM OF ANY INCUMBENT DIRECTOR. EACH ELECTED DIRECTOR SHALL HOLD OFFICE UNTIL THE SUCCESSOR TO THE DIRECTOR SHALL BE DULY ELECTED, QUALIFIED AND SEATED, OR THE DIRECTOR'S EARLIER RETIREMENT, REMOVAL FROM OFFICE OR DEATH. EACH DIRECTOR SHALL SERVE FOR A TERM OF THREE YEARS, AND SHALL SERVE FOR A MAXIMUM OF THREE CONSECUTIVE TERMS OR A TOTAL OF NINE YEARS UNLESS SUCH TERM LIMITS ARE WAIVED BY A VOTE OF THE EXECUTIVE COMMITTEE OR ELECTED OFFICER. A PERSON WHO HAS SERVED FOR AT LEAST THREE CONSECUTIVE TERMS AS AN ELECTED DIRECTOR SHALL NOT BE ELIGIBLE FOR ELECTION OR RE-ELECTION AS A DIRECTOR FOR ONE YEAR. VOLUNTARY RETIREMENT: ANY DIRECTOR MAY RETIRE AT ANY TIME BY NOTIFYING THE CHAIR OR SECRETARY IN WRITING. SUCH RETIREMENT SHALL TAKE EFFECT AT THE TIME SPECIFIED IN THE NOTICE OF RETIREMENT. REMOVAL OF ELECTED DIRECTORS: ABSENCES: ANY ELECTED DIRECTOR WHO FAILS TO ATTEND WITHOUT AN EXCUSED ABSENCE 50% OF MEETINGS OF THE BOARD OF DIRECTORS, WHETHER REGULAR OR SPECIAL, WITHIN ANY 12 MONTH PERIOD SHALL AUTOMATICALLY BE REMOVED AS A DIRECTOR. DIRECTORS MUST REQUEST, ORALLY OR IN WRITING, PRIOR TO THE MISSED MEETING OR, IF NOT POSSIBLE, BEFORE THE NEXT MEETING, THROUGH THE CHAIR OF THE PRESIDENT, THAT THEIR ABSENCE BE EXCUSED. THE NATURE OF ABSENCES FOR DIRECTORS (WHETHER EXCUSED OR UNEXCUSED) SHALL BE ANNOUNCED BY THE CHAIR AT THE BEGINNING OF EACH MEETING AND SHALL BE RECORDED IN THE MINUTES. REINSTATEMENT: THE SECRETARY SHALL IN WRITING PROMPTLY NOTIFY DIRECTORS WHO HAVE BEEN AUTOMATICALLY REMOVED. ANY DIRECTOR SO REMOVED MAY REQUEST REINSTATEMENT BY DIRECTING A LETTER TO THE CHAIR AND THE PRESIDENT SETTING FORTH THE REASON FOR THE UNEXCUSED ABSENCES. THE REQUEST FOR REINSTATEMENT SHALL BE GRANTED ONLY UPON THE VOTE OF THE BOARD. REMOVAL: AT A MEETING OF THE BOARD, ANY ELECTED DIRECTOR MAY BE REMOVED, WITH OR WITHOUT CAUSE, BY A VOTE OF TWO-THIRDS OF THE DIRECTORS IN ATTENDANCE AT THE MEETING. NOTICE OF PROPOSED BOARD ACTION PURSUANT TO THIS PROVISION SHALL BE GIVEN TO EACH BOARD MEMBER NOT LESS THAN FOUR DAYS PRIOR TO THE MEETING AT WHICH SUCH ACTION IS TO BE CONSIDERED. VACANCIES: WHENEVER A VACANCY EXISTS ON THE BOARD OF DIRECTORS, WHETHER BY DEATH, RESIGNATION OR OTHERWISE, THE VACANCY MAY BE FILLED BY A MAJORITY VOTE OF THE REMAINING VOTING DIRECTORS, EVEN THROUGH THE REMAINING VOTING DIRECTORS CONSTITUTE LESS THAN A QUORUM, AT A REGULAR OR SPECIAL MEETING OF THE BOARD. ANY PERSON ELECTED TO FILL THE VACANCY OF A DIRECTOR SHALL HAVE THE SAME QUALIFICATIONS AS WERE REQUIRED OF THE DIRECTORS WHOSE OFFICE WAS VACATED. ANY PERSON ELECTED TO FILL A VACANCY ON THE BOARD OF DIRECTORS SHALL HOLD OFFICE FOR THE UNEXPIRED TERM OF SUCH PERSON'S PREDECESSOR IN OFFICE, SUBJECT TO THE SAME POWER OF REMOVAL STATED ABOVE. THE ORGANIZATION SHALL HAVE UP TO 45 VOTING DIRECTORS AND ONE NON-VOTING DIRECTOR. THE DIRECTORS SHALL BE COMPOSED OF THE FOLLOWING: (A) THE CHAIR, VICE-CHAIR, SECRETARY AND TREASURER OF THE CORPORATION. (B) THE IMMEDIATE PAST CHAIR OF THE CORPORATION. (C) UP TO 30 ELECTED DIRECTORS. (D) THE CHAIR OF THE GOLDEN ANGEL SOCIETY (E) THE PRESIDENT AND CEO OF THE JACKSON HEALTH SYSTEM (F) THE CHAIR OF THE MIAMI-DADE COUNTY PUBLIC HEALTH TRUST (G) THE CHAIRS OF THE AUXILIARY GROUPS (H) THE PRESIDENT AND CEO OF THE FOUNDATION WHO SHALL SERVE WITH NO VOTE. ELECTION AND TERM OF OFFICE: THE MEMBERS OF THE BOARD OF DIRECTORS WHO ARE ELECTED AS DIRECTORS SHALL BE DIVIDED INTO THREE GROUPS SO AS TO ROTATE ONE THIRD OF THE BOARD EACH YEAR. THE NUMBER OF DIRECTORS IN EACH GROUP SHALL BE AS NEARLY EQUAL AS POSSIBLE. AT EACH ANNUAL MEETING OF THE BOARD, THE SUCCESSORS OF THE ELECTED DIRECTORS WHOSE TERMS ARE EXPIRING SHALL BE ELECTED FOR A THREE YEAR TERM EXPIRING AT THE THIRD SUCCESSIVE ANNUAL MEETING OF THE BOARD. IF THE NUMBER OF ELECTED DIRECTORS IS CHANGED, ANY INCREASE OR DECREASE SHALL BE APPORTIONED AMONG THE CLASSES SO AS TO MAINTAIN THE NUMBER OF DIRECTORS IN EACH GROUP AS NEARLY EQUAL AS POSSIBLE, AND ANY ADDITIONAL DIRECTORS OF ANY GROUP ELECTED TO FILL A VACANCY RESULTING FROM AN INCREASE IN SUCH GROUP SHALL HOLD OFFICE FOR A TERM THAT SHALL COINCIDE WITH THE REMAINING TERM OF THAT GROUP, BUT IN NO CASE SHALL A DECREASE IN THE NUMBER OF DIRECTORS SHORTEN THE TERM OF ANY INCUMBENT DIRECTOR. EACH ELECTED DIRECTOR SHALL HOLD OFFICE UNTIL THE SUCCESSOR TO THE DIRECTOR SHALL BE DULY ELECTED, QUALIFIED AND SEATED, OR THE DIRECTOR'S EARLIER RETIREMENT, REMOVAL FROM OFFICE OR DEATH. EACH DIRECTOR SHALL SERVE FOR A TERM OF THREE YEARS, AND SHALL SERVE FOR A MAXIMUM OF THREE CONSECUTIVE TERMS OR A TOTAL OF NINE YEARS UNLESS SUCH TERM LIMITS ARE WAIVED BY A VOTE OF THE EXECUTIVE COMMITTEE OR ELECTED OFFICER. A PERSON WHO HAS SERVED FOR AT LEAST THREE CONSECUTIVE TERMS AS AN ELECTED DIRECTOR SHALL NOT BE ELIGIBLE FOR ELECTION OR RE-ELECTION AS A DIRECTOR FOR ONE YEAR. VOLUNTARY RETIREMENT: ANY DIRECTOR MAY RETIRE AT ANY TIME BY NOTIFYING THE CHAIR OR SECRETARY IN WRITING. SUCH RETIREMENT SHALL TAKE EFFECT AT THE TIME SPECIFIED IN THE NOTICE OF RETIREMENT. REMOVAL OF ELECTED DIRECTORS: ABSENCES: ANY ELECTED DIRECTOR WHO FAILS TO ATTEND WITHOUT AN EXCUSED ABSENCE 50% OF MEETINGS OF THE BOARD OF DIRECTORS, WHETHER REGULAR OR SPECIAL, WITHIN ANY 12 MONTH PERIOD SHALL AUTOMATICALLY BE REMOVED AS A DIRECTOR. DIRECTORS MUST REQUEST, ORALLY OR IN WRITING, PRIOR TO THE MISSED MEETING OR, IF NOT POSSIBLE, BEFORE THE NEXT MEETING, THROUGH THE CHAIR OR THE PRESIDENT, THAT THEIR ABSENCE BE EXCUSED. THE NATURE OF ABSENCES FOR DIRECTORS (WHETHER EXCUSED OR UNEXCUSED) SHALL BE ANNOUNCED BY THE CHAIR AT THE BEGINNING OF EACH MEETING AND SHALL BE RECORDED IN THE MINUTES. REINSTATEMENT: THE SECRETARY SHALL IN WRITING PROMPTLY NOTIFY DIRECTORS WHO HAVE BEEN AUTOMATICALLY REMOVED. ANY DIRECTOR SO REMOVED MAY REQUEST REINSTATEMENT BY DIRECTING A LETTER TO THE CHAIR AND THE PRESIDENT SETTING FORTH THE REASON FOR THE UNEXCUSED ABSENCES. THE REQUEST FOR REINSTATEMENT SHALL BE GRANTED ONLY UPON THE VOTE OF THE BOARD. REMOVAL: AT A MEETING OF THE BOARD, ANY ELECTED DIRECTOR MAY BE REMOVED, WITH OR WITHOUT CAUSE, BY A VOTE OF TWO-THIRDS OF THE DIRECTORS IN ATTENDANCE AT THE MEETING. NOTICE OF PROPOSED BOARD ACTION PURSUANT TO THIS PROVISION SHALL BE GIVEN TO EACH BOARD MEMBER NOT LESS THAN FOUR DAYS PRIOR TO THE MEETING AT WHICH SUCH ACTION IS TO BE CONSIDERED. VACANCIES: WHENEVER A VACANCY EXISTS ON THE BOARD OF DIRECTORS, WHETHER BY DEATH, RESIGNATION OR OTHERWISE, THE VACANCY MAY BE FILLED BY A MAJORITY VOTE OF THE REMAINING VOTING DIRECTORS, EVEN THROUGH THE REMAINING VOTING DIRECTORS CONSTITUTE LESS THAN A QUORUM, AT A REGULAR OR SPECIAL MEETING OF THE BOARD. ANY PERSON ELECTED TO FILL THE VACANCY OF A DIRECTOR SHALL HAVE THE SAME QUALIFICATIONS AS WERE REQUIRED OF THE DIRECTORS WHOSE OFFICE WAS VACATED. ANY PERSON ELECTED TO FILL A VACANCY ON THE BOARD OF DIRECTORS SHALL HOLD OFFICE FOR THE UNEXPIRED TERM OF SUCH PERSON'S PREDECESSOR IN OFFICE, SUBJECT TO THE SAME POWER OF REMOVAL STATED ABOVE.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B THE AFFAIRS OF THE FOUNDATION SHALL BE MANAGED, AND ALL CORPORATE POWERS SHALL BE EXERCISED BY THE MEMBERS OF THE BOARD OF DIRECTORS. THE CHAIR AND, IN HIS ABSENCE, THE VICE CHAIR AND/OR PRESIDENT AND CEO SHALL EXECUTE CONTRACTS WHICH ARE WITHIN THE FOUNDATION'S BUDGET OR HAVE BEEN OTHERWISE AUTHORIZED BY THE BOARD OR THE EXECUTIVE COMMITTEE, AS WELL AS INSTRUMENTS AND DOCUMENTS ON BEHALF OF THE FOUNDATION. ANY CONTRACT INVOLVING CONSIDERATION OF 100,000 OR MORE MUST BE EXECUTED BY THE CHAIR OR VICE CHAIR. THE BOARD, EXCEPT AS REQUIRED BY LAW, THE ARTICLES OF INCORPORATION, OR THE BYLAWS, MAY AUTHORIZE ANY OTHER OFFICERS OR AGENTS OF THE FOUNDATION, IN ADDITION TO THE OFFICERS SO AUTHORIZED BY THE BYLAWS, TO ENTER INTO ANY CONTRACTS OR EXECUTE AND DELIVER ANY INSTRUMENT OR DOCUMENTS IN THE NAME OF AND ON BEHALF OF THE FOUNDATION AND SUCH AUTHORITY MAY BE GENERAL OR CONFINED TO SPECIFIC INSTANCES. ALL CHECKS, DRAFTS, LOANS, OR OTHER ORDERS FOR THE PAYMENT OF MONEY, NOTES, OR OTHER EVIDENCE OF INDEBTEDNESS ISSUED IN THE NAME OF THE FOUNDATION SHALL BE SIGNED BY SUCH OFFICER OR OFFICERS, AGENT OR AGENTS OF THE FOUNDATION AND IN SUCH MANNER AS DETERMINED BY THE BOARD. IN THE ABSENCE OF SUCH A DETERMINATION, SUCH INSTRUMENTS SHALL BE SIGNED BY THE TREASURER AND COUNTERSIGNED BY THE PRESIDENT AND CEO. ALL FUNDS OF THE FOUNDATION SHALL BE DEPOSITED AND/OR INVESTED TO THE CREDIT OF THE FOUNDATION IN FINANCIAL INSTITUTIONS SELECTED BY THE BOARD. THE BOARD MAY ACCEPT ON BEHALF OF THE FOUNDATION ANY CONTRIBUTIONS, GIFTS, BEQUESTS OR DEVISE FOR GENERAL OR FOR SPECIAL PURPOSE OF THE FOUNDATION, AND MAY ACCEPT IN KIND PERSONAL SERVICE IN ITS DISCRETION. THE BOARD MAY ELECT OR APPOINT ANY PERSON OR PERSONS TO ACT IN AN ADVISORY CAPACITY TO THE FOUNDATION. THE BOARD SHALL REVIEW AND EITHER APPROVE OR MODIFY AND APPROVE THE FOUNDATIONS ANNUAL BUDGET PRIOR TO THE BEGINNING OF THE FISCAL YEAR FOR WHICH IT APPLIES. THE BOARD MAY ALTER, AMEND OR REPEAL ANY NEW BYLAWS BY A TWO THIRDS VOTE. THE BOARD OF DIRECTORS BY A MAJORITY VOTE MAY AUTHORIZE THE FORMATION OF AUXILIARY ORGANIZATIONS TO ASSIST IN THE FULFILLMENT OF THE PURPOSE OF THE FOUNDATION.
OFFICERS WHO CANNOT BE REACHED FORM 990, PAGE 6, PART VI, LINE 9 RODRIGUEZ ROLANDO 9 ISLAND AVE APT 507 MIAMI BEACH, FL 33139 THOMAS SCHRAMM 14840 SW 144 TERRACE MIAMI, FL 33196
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B A DRAFT COPY OF FORM 990 IS SUBMITTED TO THE MEMBERS OF THE EXECUTIVE COMMITTEE FOR REVIEW. AFTER THEIR REVIEW AND APPROVAL THE RETURN IS SUBMITTED TO THE IRS.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE POLICY REQUIRES ALL DIRECTORS TO ANNUALLY SIGN A CONFLICT OF INTEREST CERTIFICATE AS A CONDITION OF MEMBERSHIP ON THE BOARD OF DIRECTORS. UPON AT LEAST FOUR DAYS WRITTEN NOTICE TO THE DIRECTOR INVOLVED, THE BOARD SHALL HAVE AUTHORITY TO DETERMINE IF A CONFLICT EXISTS AND TAKE APPROPRIATE REMEDIATION ACTION. A DIRECTOR HAVING A CONFLICT OF INTEREST OR A CONFLICT OF RESPONSIBILITY ON ANY MATTER INVOLVING THE CORPORATION AND ANY OTHER BUSINESS OR PERSON, SHALL REFRAIN FROM VOTING ON SUCH MATTER. NO DIRECTOR SHALL USE HIS OR HER POSITION AS A DIRECTOR OF THE CORPORATION FOR HIS OR HER OWN INDIRECT FINANCIAL GAIN. AS AN ADDITIONAL ASSURANCE, THE AUDIT COMMITTEE ADOPTED IN DECEMBER 2009 A NEW PROCEDURE WHICH STATES THAT AS A MATTER OR DUE COURSE OF THE YEARLY AUDIT THE INDEPENDENT AUDITORS ARE TO OBTAIN A WRITTEN CONFIRMATION FROM ALL OFFICERS AND DIRECTORS REAFFIRMING THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FOR FISCAL YEAR ENDED SEPTEMBER 30, 2013 ALL OFFICERS AND DIRECTORS REAFFIRMED THEIR COMPLIANCE WITH THE POLICY. ALL EMPLOYEES MUST SIGN A CONFLICT OF INTEREST STATEMENT UPON BEING HIRED. SHOULD A POTENTIAL CONFLICT ARISE THEN THE POLICY REQUIRES THEY BRING IT TO THE ATTENTION OF THE HUMAN RESOURCES DEPARTMENT. SHOULD AN UNDISCLOSED CONFLICT ARISE THEN HR WOULD INVESTIGATE AND MAKE A DETERMINATION.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A COMPENSATION FOR THE CEO IS DETERMINED BY THE EMPLOYMENT PRACTICES COMMITTEE, WHICH BRINGS A RECOMMENDATION TO THE BOARD FOR APPROVAL. THE COMMITTEE BENCHMARKS COMPENSATION FOR SIMILAR POSITIONS IN THE LOCAL MARKET.
COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE COMPENSATION FOR KEY EMPLOYEES IS REVIEWED AND ESTABLISHED BY THE EMPLOYMENT PRACTICES COMMITTEE APPOINTED BY THE BOARD OF DIRECTORS. THE COMMITTEE BENCHMARKS COMPENSATION FOR SIMILAR POSITIONS IN THE LOCAL MARKET.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 ANNUAL AUDIT REPORT IS AVAILABLE UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 EVENT EXPENSES REPORTED UNDER FUNDRAISING EXPENSES 487,015 IN AUDIT BUT NETTED AGAINS EVENT REVENUE 0 EVENT EXPENSES REPORTED UNDER FUNDRAISING EXPENSES IN AUDI -487,015 BOOK / TAX DEPRECIATION DIFFERENCE -430
OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 MISCELLANEOUS DIFFERENCE 430
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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