Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
LOMA LINDA MERCANTILE
Employer identification number
95-3858272
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
LOMA LINDA MERCANTILE
Employer identification number
95-3858272
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THERE SHALL BE A SINGLE CLASS OF MEMBERS OF LOMA LINDA MERCANTILE (LLM) WHICH SHALL BE LOMA LINDA UNIVERSITY ADVENTIST HEALTH SCIENCES CENTER (LLUAHSC) ACTING BY AND THROUGH ITS BOARD. MEMBERSHIP IN THIS CORPORATION SHALL TERMINATE WHEN AN INDIVIDUAL CEASES, FOR WHATEVER REASON, TO BE A MEMBER OF THE LLUAHSC BOARD. NO MEMBER SHALL HAVE ANY RIGHT OR INTEREST IN ANY OF THE PROPERTY OR ASSETS OF LLM. NO MEMBER SHALL TRANSFER FOR VALUE OR OTHERWISE A MEMBERSHIP OR ANY RIGHT ARISING THEREFROM.
FORM 990, PART VI, SECTION A, LINE 7A
LLUAHSC, AS THE CORPORATE MEMBER, ELECTS THE BOARD OF TRUSTEES AT ITS QUINQUENNIAL MEETING. LLUAHSC SHALL ALSO HAVE THE POWER TO FILL VACANCIES ON THE BOARD OF TRUSTEES BETWEEN THE QUINQUENNIAL ORGANIZATION MEETINGS.
FORM 990, PART VI, SECTION A, LINE 7B
THE POWERS RESERVED BY LLUAHSC, WHICH SHALL ONLY BE EXERCISED BY THE LLUAHSC BOARD UPON A MAJORITY VOTE OF LLUAHSC'S TRUSTEES PRESENT AND VOTING AT A REGULAR OR SPECIAL MEETING WHENEVER A QUORUM IS PRESENT, ARE TO: 1 APPROVE OR RATIFY ALL CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS OF LLM. 2 ESTABLISH GUIDELINES FOR BORROWING OF FUNDS BY LLM. 3 APPROVE ANY MERGER, CONSOLIDATION, DISSOLUTION, SALE, OR TRANSFER OF MORE THAN TEN MILLION DOLLARS OF LLM. 4 APPROVE ANY EXCEPTIONS TO THE GUIDELINES FOR THE BORROWING OF FUNDS REQUESTED BY LLM'S BOARD. 5 REQUIRE THAT LLM ESTABLISH CONTRACTING GUIDELINES. 6 REQUIRE THAT LLM HAVE A COMPLIANCE PROGRAM.
FORM 990, PART VI, SECTION B, LINE 11
THIS FORM 990 IS REVIEWED BY INTERNAL AUDIT AND MANAGEMENT AND IS MADE AVAILABLE TO THE AUDIT COMMITTEE AND THE BOARD FOR REVIEW AND COMMENT BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C
GENERAL COUNSEL ANNUALLY OBTAINS STATEMENTS OF DISCLOSURE FROM TRUSTEES, OFFICERS, ADMINISTRATORS, KEY EMPLOYEES, AND OTHERS WHO MAKE OR AFFECT SIGNIFICANT DECISIONS AND REVIEWS THE FINDINGS WITH APPROPRIATE BOARDS AND COMMITTEES. THE BOARD OF TRUSTEES MAKES THE DECISIONS REGARDING QUESTIONS WHICH HAVE NOT BEEN SATISFACTORILY ANSWERED AFTER ADMINISTRATIVE CONSIDERATION.
FORM 990, PART VI, SECTION B, LINE 15
LLUAHSC, LOMA LINDA MERCANTILE'S PARENT ORGANIZATION, EMPLOYS AN INDEPENDENT OUTSIDE CONSULTING FIRM TO BENCHMARK COMPENSATION FOR LLUAHSC EMPLOYEES. LOMA LINDA MERCANTILE'S CEO AND CFO ARE EMPLOYED BY LLUAHSC. THE LLUAHSC EXECUTIVE COMPENSATION COMMITTEE USES THE RESULTS OF THE INDEPENDENT SURVEY TO ESTABLISH PAY SCALES FOR THE NEXT FISCAL YEAR. THE EXECUTIVE COMPENSATION COMMITTEE SETS THE TOTAL COMPENSATION BELOW THE INDUSTRY MEAN AND MEDIAN AMOUNTS PROVIDED IN THE SURVEY. THE EXECUTIVE COMPENSATION COMMITTEE IS COMPOSED OF TRUSTEES APPOINTED BY THE LLUAHSC BOARD WHO ARE INDEPENDENT OF LLUAHSC'S MANAGEMENT. THE EXECUTIVE COMPENSATION COMMITTEE IS APPOINTED BY THE LLUAHSC BOARD OF TRUSTEES TO HAVE DIRECT RESPONSIBILITY FOR ESTABLISHING COMPENSATION, POLICIES, AND BENEFITS FOR THE SENIOR EXECUTIVES OF LLUAHSC. THE COMMITTEE'S PROCESS INCLUDES CONTEMPORANEOUS SUBSTANTIATION OF DELIBERATIONS AND DECISIONS. THIS PROCESS WAS LAST UNDERTAKEN IN 12/12 FOR THE POSITION OF EVP, HOSPITAL AFFAIRS & CEO, LLUMC HELD BY FIKE, RUTHITA J.. THIS PROCESS WAS LAST UNDERTAKEN IN 12/12 FOR THE POSITION OF EVP, MEDICAL AFFAIRS & DEAN, SCHOOL OF MEDICINE HELD BY HADLEY, HENRY ROGER. THIS PROCESS WAS LAST UNDERTAKEN IN 12/12 FOR THE POSITION OF PRESIDENT & CEO HELD BY HART, RICHARD HENRY. THIS PROCESS WAS LAST UNDERTAKEN IN 12/12 FOR THE POSITION OF EVP, FINANCE & ADMINISTRATION & CFO HELD BY LANG, KEVIN J.. THIS PROCESS WAS LAST UNDERTAKEN IN 12/12 FOR THE POSITION OF SVP, FINANCE HELD BY MOHR, STEVEN LAWRENCE.
FORM 990, PART VI, SECTION C, LINE 18
THE IRS FORM 990 IS AVAILABLE ON THE GUIDESTAR.COM WEBSITE AND ALSO MAY BE OBTAINED BY MAKING A REQUEST TO THE CFO AT 11175 CAMPUS ST., CSP 11006, LOMA LINDA, CA 92354.
FORM 990, PART VI, SECTION C, LINE 19
LOMA LINDA MERCANTILE WILL MAKE ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST AND IN ACCORDANCE WITH IRS GUIDELINES. THE CONFLICT OF INTEREST POLICY IS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE FOR EMPLOYEES. THE FINANCIAL STATEMENTS ARE INCLUDED IN THE IRS FORM 990 WHICH IS AVAILABLE TO THE PUBLIC ON THE GUIDESTAR WEBSITE.
FORM 990, PART VII, LINE 1A:
FOR EMPLOYEES OF LLUAHSC OR LLUAHSC AFFILIATES (ORGANIZATION(S)) RELATED TO THE FILING ORGANIZATION WHO DEVOTE LESS THAN FULL-TIME TO THE FILING ORGANIZATION (BASED UPON THE AVERAGE NUMBER OF HOURS PER WEEK SHOWN IN PART VII, SECTION A, COLUMN (B) OF THE RETURN) THE COMPENSATION AMOUNTS SHOWN IN COLUMNS (E) AND (F) WERE PROVIDED IN CONJUNCTION WITH THEIR RESPONSIBILITIES AND ROLES IN OTHER POSITIONS FOR ORGANIZATIONS RELATED TO THE FILING ORGANIZATION. THESE INDIVIDUALS EACH DEVOTE APPROXIMATELY 50 HOURS PER WEEK SERVING IN THEIR RESPECTIVE POSITIONS WITHIN THE ORGANIZATION.
FORM 990, PART XII, LINE 2B:
THE FINANCIAL STATEMENTS OF LOMA LINDA MERCANTILE WERE AUDITED BY AN INDEPENDENT FIRM AS PART OF THE 2013 COMBINED FINANCIAL STATEMENT AUDIT OF LOMA LINDA UNIVERSITY MEDICAL CENTER AND ITS AFFILIATES (WHICH ENCOMPASSES LOMA LINDA UNIVERSITY MEDICAL CENTER, LOMA LINDA MERCANTILE, LOMA LINDA UNIVERSITY MEDICAL ENTERPRISES, LOMA LINDA UNIVERSITY FACULTY PHARMACY, LOMA LINDA UNIVERSITY BEHAVIORAL MEDICAL CENTER, THE LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL FOUNDATION, LOMA LINDA UNIVERSITY HEALTHCARE PROPERTIES, LLC, AND PHYSICIANS HOSPITAL OF MURRIETA, LLC).
FORM 990, PART XII, LINE 2C:
DUE TO THE FACT THAT LOMA LINDA MERCANTILE'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF THE COMBINED FINANCIAL STATEMENT ADUIT FOR LOMA LINDA UNIVERSITY MEDICAL CENTER AND ITS AFFILIATES, LLUMC'S FINANCE AND AUDIT COMMITTEES OF THE BOARD OF TRUSTEES ALSO ASSUME RESPONSIBILITY FOR OVERSIGHT OF LOMA LINDA MERCANTILE'S FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT FIRM.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.