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
University Medical Center Foundation of El Paso
Employer identification number
74-2540513
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) 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.") .
194,767
909,286
3,048,393
1,370,638
2,876,550
8,399,634
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......
0
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
18,408
56,542
392,461
466,103
610,439
1,543,953
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
213,175
965,828
3,440,854
1,836,741
3,486,989
9,943,587
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
9,943,587
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...
213,175
965,828
3,440,854
1,836,741
3,486,989
9,943,587
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
432
0
0
0
0
432
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
432
0
0
0
0
432
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
213,607
965,828
3,440,854
1,836,741
3,486,989
9,944,019
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
99.996 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.919 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.004 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.081 %
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
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
University Medical Center Foundation of El Paso
Employer identification number
74-2540513
Identifier
Return Reference
Explanation
CLASSES OF MEMBERS
FORM 990, PART VI, LINE 6
THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO IS THE SOLE MEMBER OF THE UNIVERSITY MEDICAL CENTER FOUNDATION OF EL PASO.
MEMBERS MAY ELECT GOVERNING BODY
FORM 990, PART VI, LINE 7A
THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO ELECTS ALL DIRECTORS AND EX OFFICIO DIRECTORS (WHO ARE OFFICERS OF UNIVERSITY MEDICAL CENTER OF EL PASO).
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PART VI, LINE 7B
THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO HAS THE RIGHT TO APPOINT AND REMOVE DIRECTORS, APPROVE AMENDMENTS TO BYLAWS, AND APPROVE CERTAIN FINANCIAL TRANSACTIONS.
PROCESS TO REVIEW FORM 990
FORM 990, PART VI, LINE 11B
THE ORGANIZATION ENGAGES AN INDEPENDENT ACCOUNTING FIRM EXPERIENCED IN THE PREPARATION OF THE FORM 990 TO PREPARE ITS FORM 990. THE ORGANIZATION'S MANAGEMENT, ACCOUNTING AND LEGAL PERSONNEL REVIEW THE FORM 990. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS PRIOR TO ITS FILING.
CONFLICT OF INTEREST POLICY
FORM 990, PART VI, LINE 12C
THE CONFLICT OF INTEREST POLICY IS CONTAINED IN EL PASO COUNTY HOSPITAL DISTRICT ("EPCHD") POLICY NUMBER CP-42. THIS POLICY APPLIES TO UNIVERSITY MEDICAL CENTER OF EL PASO AND ITS AFFILIATES. THE POLICY IS DESIGNED TO ADDRESS AND IDENTIFY POTENTIAL, ACTUAL, AND APPARENT CONFLICTS OF INTEREST. IDENTIFICATION OF A CONFLICT OF INTEREST IS NECESSARY TO ENSURE APPROPRIATE STEPS ARE TAKEN TO PROPERLY ADDRESS, CERTIFY, AND ABSTAIN FROM THE DECISION MAKING PROCESS OR ANY INTERACTIONS THAT MAY EXERCISE INFLUENCE WHEN APPROVING OR NEGOTIATING NEW AND CONTINUED BUSINESS RELATIONSHIPS. IF A CONFLICT OF INTEREST DOES EXIST BETWEEN AN EPCHD LEADER AND A BUSINESS ENTITY, PROPER DOCUMENTATION TO DISCLOSE THE FINANCIAL/MATERIAL INTEREST IS REQUIRED. UPON EMPLOYMENT AND ANNUALLY THEREAFTER, EPCHD LEADERS SHALL SIGN A CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY CERTIFYING THAT THEY RECEIVED, READ, UNDERSTAND, AND AGREE TO COMPLY WITH THIS CONFLICT OF INTEREST POLICY. AN EPCHD LEADER (INCLUDES EPCHD SUBSIDIARY LEADER) INCLUDES BOARD OF MANAGERS, CHIEF EXECUTIVES, VICE-PRESIDENTS, MANAGERS, SUPERVISORS, DIRECTORS, ADMINISTRATORS, MEDICAL DIRECTORS, COMMITTEE MEMBERS, OR OTHERS AS IDENTIFIED BY THE CEO THAT HAVE THE ABILITY TO APPROVE, OR ACTIVELY PARTICIPATE IN THE DECISION MAKING PROCESS WHEN NEGOTIATING A BUSINESS RELATIONSHIP THAT IS OF FINANCIAL OR MATERIAL INTEREST TO EPCHD. THE CEO, COMPLIANCE OFFICER, AND THE CHIEF LEGAL OFFICER SHALL REVIEW CONFLICT OF INTEREST CERTIFICATION FORMS THAT DISCLOSE A POTENTIAL CONFLICT OF INTEREST OR OUTSIDE INTEREST TO DETERMINE APPROPRIATE ACTION. FOR CONFLICTS DISCLOSED ON THE CERTIFICATION FORM, MEMOS ARE ISSUED FROM THE COMPLIANCE OFFICER TO THE LEADER THAT OUTLINES THE PROCESS FOR ALLOWING THE CONFLICT TO EXIST. TRANSPARENCY, DISCLOSURE, AND ABSTINENCE FROM THE DECISION MAKING, AND REMOVAL OF OVERSIGHT OF THE VENDOR PAYMENT IS CLEARLY STATED IN THE MEMO. THE SUPERVISOR IS COPIED ON THE CORRESPONDENCE AND ALSO HAS AUTHORITY TO DISALLOW POTENTIAL CONFLICT RELATIONSHIPS THAT MAY IMPACT WORKFLOW PROCESSES. IF AN ACTUAL, POTENTIAL, OR APPARENT CONFLICT OF INTEREST EXISTS THE EPCHD LEADER SHALL BE EXCLUDED FROM THE DECISION MAKING PROCESS. IF AN OUTSIDE INTEREST EXISTS, A DETERMINATION SHALL BE MADE WHETHER THE OUTSIDE INTEREST MAY CONTINUE OR SHOULD BE TERMINATED.
COMPENSATION REVIEW
FORM 990, PART VI, LINE 15A & 15B
THE UNIVERSITY MEDICAL CENTER FOUNDATION OF EL PASO ("FOUNDATION") DOES NOT HAVE EMPLOYEES. ALL INDIVIDUALS PERFORMING WORK FOR THE FOUNDATION ARE EMPLOYEES OF THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO ("UMC") AND SUBJECT TO ITS HUMAN RESOURCE POLICIES AND ESTABLISHED SALARY RANGES FOR ALL POSITIONS. SALARY RANGES, SALARY SURVEYS, AND MARKET ANALYSIS ARE CONSIDERED WHEN DETERMINING COMPENSATION FOR ALL EMPLOYEES. THE UMC BOARD OF MANAGERS APPROVES THE COMPENSATION FOR ITS CEO. THE UMC CEO APPROVES THE COMPENSATION FOR THE OFFICERS AND THE CEO OF THE FOUNDATION. THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO CEO APPROVES THE COMPENSATION FOR THE UNIVERSITY MEDICAL CENTER FOUNDATION OF EL PASO OFFICERS AND KEY EMPLOYEES.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, LINE 19
THE UNIVERSITY MEDICAL CENTER FOUNDATION OF EL PASO'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT
FORM 990, PART XII, LINE 2C
THE BOARD OF DIRECTORS OF THE UNIVERSITY MEDICAL CENTER FOUNDATION OF EL PASO ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT.
DONATED SERVICES AND USE OF FACILITIES
FORM 990, PART VIII & PART IX
THE ORGANIZATION RECEIVES DONATED SERVICES AND USE OF FACILITIES FROM ITS SOLE MEMBER, THE EL PASO COUNTY HOSPITAL DISTRICT D/B/A UNIVERSITY MEDICAL CENTER OF EL PASO. THE TOTAL AMOUNT OF DONATED SERVICES AND USE OF FACILITIES RECEIVED FOR THE CURRENT YEAR WAS $702,296. THE REVENUE AND EXPENSE FOR THESE DONATED SERVICES AND USE OF FACILITIES HAS BEEN EXCLUDED FROM THE AMOUNTS REPORTED ON PART VIII AND PART IX OF THE FORM 990 AS REQUIRED BY THE IRS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.