Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
COLUMBIA UNIV RETIREE MEDICAL & LIFE INS BENEFITS TRUST
Employer identification number
13-3800106
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
(A)
TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
135598093
02
Yes
10,961,650
Total
10,961,650
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS TRUST PROVIDES HEALTH AND LIFE INSURANCE BENEFITS COVERING RETIRED OFFICERS AND SUPPORT STAFF OF THE TRUSTEES OF COLUMBIA UNIVERSITY IN NEW YORK CITY.
Schedule A (Form 990 or 990-EZ) 2012
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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
COLUMBIA UNIV RETIREE MEDICAL & LIFE INS BENEFITS TRUST
Employer identification number
13-3800106
Identifier
Return Reference
Explanation
FORM 990, PART VI, LINE 3
DELEGATION OF CONTROL OVER MANAGEMENT DUTIES
COLUMBIA UNIVERSITY HAS ASSUMED RESPONSIBILITY FOR THE ADMINISTRATION AND MANAGEMENT OF COLUMBIA UNIVERSITY RETIREE MEDICAL & LIFE INSURANCE BENEFITS TRUST ("CURML"). FROM 990, PART VI, LINE 6 MEMBERS OF THE ORGANIZATION THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK IS THE SETTLOR AND THE SOLE MEMBER OF CURML AND HAS THE RIGHT TO APPOINT THE TRUSTEES OF CURML.
FORM 990, PART VI, LINE 7A
ELECTION OF THE GOVERNING BODY
THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK IS THE SETTLOR AND THE SOLE MEMBER OF CURML AND HAS THE RIGHT TO APPOINT THE TRUSTEES OF CURML.
FORM 990, PART VI, LINE 8B
COMMITTEES OF THE GOVERNING BODY
THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, LINE 11B
REVIEW PROCESS FOR FORM 990
COLUMBIA UNIVERSITY RETIREE MEDICAL & LIFE INSURANCE BENEFITS TRUST "CURML" IS A SUPPORTING ORGANIZATION FOR THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK ("THE UNIVERSITY"). THE UNIVERSITY HAS ASSUMED RESPONSIBILITY FOR THE ADMINISTRATION OF CURML. FORM 990 WAS REVIEWED BY THE OFFICIALS OF THE UNIVERSITY. THESE OFFICIALS INCLUDE THE UNIVERSITY'S DEPUTY CONTROLLER AND A REPRESENTATIVE FROM THE UNIVERSITY'S GENERAL COUNSEL OFFICE.
FORM 990, PART VI, LINE 12C
CONFLICT OF INTEREST POLICY
CURML FOLLOWS THE CONFLICT OF INTEREST POLICY OF ITS SOLE MEMBER, THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK. EACH OFFICER OR KEY EMPLOYEE OF COLUMBIA UNIVERSITY WHO SERVES AS A TRUSTEE OR OFFICER OF CURML IS SUBJECT TO THE "STATEMENT OF UNIVERSITY POLICY ON CONFLICTS OF INTEREST," AND IS REQUIRED TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THESE DISCLOSURES ARE REVIEWED THROUGH AN ADMINISTRATIVE PROCESS. ANY DISCLOSURES THAT COULD GIVE RISE TO CONFLICTS AS IDENTIFIED THROUGH SUCH REVIEW ARE REPORTED TO AN APPROPRIATE SENIOR OFFICER. ANY SUBSTANTIVE CONCERNS ARE ALSO REPORTED TO THE CHAIR OF THE UNIVERSITY'S BOARD OF TRUSTEES.
FORM 990, PART VI, LINE 13
WHISTLEBLOWER POLICY
THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK HAS A WRITTEN WHISTLEBLOWER POLICY WHICH APPLIES TO THE ACTIVITIES OF CURML.
FORM 990, PART VI, LINE 14
DOCUMENT RETENTION POLICY
THE UNIVERSITY'S DOCUMENT RETENTION AND DESTRUCTION POLICY APPLIES TO ALL BOOKS AND RECORDS HELD BY THE UNIVERSITY.
FORM 990, PART VI, LINE 15A & 15B
COMPENSATION POLICY
MS. SULLIVAN IS AN OFFICER OF THE UNIVERSITY. AS SUCH, HER COMPENSATION IS REVIEWED AND APPROVED BY A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT UNIVERSITY TRUSTEES. THE COMMITTEE REVIEWS COMPARABILITY DATA AND MINUTES OF ITS DELIBERATIONS ARE RECORDED CONTEMPORANEOUSLY WITH ANY ACTION. MS. SMITH AND MS. QUAN ARE NOT OFFICERS OR KEY EMPLOYEES OF THE UNIVERSITY. THEIR COMPENSATION IS DETERMINED IN ACCORDANCE WITH THE UNIVERSITY'S REGULAR COMPENSATION PRACTICES APPLICABLE TO SIMILARLY SITUATED EMPLOYEES.
FORM 990, PART VI, LINE 19
DOCUMENTS AVAILABLE FOR INSPECTION
CURML IS A SUPPORTING ORGANIZATION OF COLUMBIA UNIVERSITY. THE UNIVERSITY HAS ASSUMED RESPONSIBILITY FOR THE ADMINISTRATION OF CURML. COLUMBIA UNIVERSITY'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE ON ITS WEBSITE AT WWW.COLUMBIA.EDU.
FORM 990, PART VII
AVERAGE HOURS
FOR ALL INDIVIDUALS DISCLOSED ON PART VII, AVERAGE HOURS FOR RELATED ORGANIZATIONS IS 60 HOURS PER WEEK. TIME DEVOTED TO THE ACTIVITIES OF CURML VARIES WITH THE NEEDS OF THE ORGANIZATION.
FORM 990, PART XII, LINE 2C
AUDIT OVERSIGHT
THE CONSOLIDATED FINANCIAL STATEMENTS OF COLUMBIA UNIVERSITY, FOR WHICH CURML IS A SUPPORTING ORGANIZATION, ARE AUDITED BY PRICEWATERHOUSECOOPERS ("PWC"), AN INDEPENDENT AUDITOR. PWC ALSO AUDITS THE FINANCIAL STATEMENTS OF CURML. THE UNIVERSITY'S BOARD OF TRUSTEES HAS AN AUDIT COMMITTEE COMPRISED OF INDEPENDENT TRUSTEES WHICH IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT, REVIEW AND COMPILATION OF THE UNIVERSITY'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR FOR THE UNIVERSITY AND CURML.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.