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
MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH
Employer identification number
91-2054035
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.") ....
1,127,932
1,980,221
1,889,995
1,825,336
2,248,737
9,072,221
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
1,127,932
1,980,221
1,889,995
1,825,336
2,248,737
9,072,221
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)..
1,518,051
6
Public support. Subtract line 5 from line 4.
7,554,170
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..
1,127,932
1,980,221
1,889,995
1,825,336
2,248,737
9,072,221
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
28,700
16,097
1,140
45,937
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
92,466
116,226
35,862
244,554
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).
9,362,712
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,290
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
80.680 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
82.060 %
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
MARSHA RIVKIN CENTER FOR OVARIAN CANCER RESEARCH
Employer identification number
91-2054035
Return Reference
Explanation
Form 990, Part VI, Section A, line 2
Melissa Rivkin and Dr. Saul Rivkin have a family relationship.
Form 990, Part VI, Section A, line 6
The Marsha Rivkin Center for Ovarian Cancer Research has three members: Swedish Health Services, The Fred Hutchinson Cancer Research Center and Saul Rivkin, MD.
Form 990, Part VI, Section A, line 7a
Members can elect the following number of Directors to the Board of Directors: Swedish Health Services - 3 Fred Hutchinson Cancer Research Center - 3 Saul Rivkin, MD - 1
Form 990, Part VI, Section A, line 7b
The affairs of the corporation are managed by the Board of Directors, except that the following actions by the Board of Directors are subject to approval by the founding members: a) Amendment of the articles of incorporation and bylaws. b) Adoption of operating and capital budgets. c) Appointment and removal of directors. d) Increase or decrease in size of the board of directors. e) Selection, termination and compensation of officers and senior management. f) Incurrence of debt which exceeds two percent (2%) or more of the amount of debt included in the adopted and approved operating or capital budgets. g) Purchases or expenditures on behalf of the corporation in excess of twenty thousand dollars ($20,000) not included in the adopted and approved operating or capital budgets. h) Entering into contracts or grants on behalf of the corporation under which the corporation provides or receives goods, services, funds or credit in excess of five hundred thousand dollars ($500,000).
Form 990, Part VI, Section B, line 11
The Form 990 is prepared internally by experienced accounting staff of Swedish Health Services and reviewed by the Providence Health & Services Director of Taxes and external consultants. The Executive Director and signing Treasurer will review the Form 990 in detail. Once approved, an electronic copy of the Form 990 is emailed to the Board prior to filing with the IRS.
Form 990, Part VI, Section B, line 12
Marsha Rivkin Center for Ovarian Cancer Research is subject to the conflict of interest policy of Swedish Health Services. Covered persons are defined as the Executive Director, management and key employees of the Marsha Rivkin Center for Ovarian Cancer Research (MRC). Board members and covered persons are required to complete a conflict of interest questionnaire annually and disclose any affiliations, interest or relationships and/or any transactions the individual and/or his or her family members have engaged in that might give rise to an actual, apparent or potential conflict of interest. The policy defines family members and describes what constitutes conflicts of interest. It requires individuals to report any further financial interest, situation, activity, interest or conduct that may develop before completion of the next annual questionnaire. The conflict of interest questionnaire includes an annual statement that board members and covered persons (a) have received a copy of the policy, (b) have read and understood the policy, (c) agree to comply with the policy, (d) understand that the policy applies to committees and subcommittees, (e) understand that MRC is a charitable organization that must engage primarily in exempt activates, (f) agree to report to the appropriate manager or committee chair any change to matters previously disclosed on the conflict of interest questionnaire, (g) state that the information provided in the conflict of interest questionnaire is true and accurate to the best of his or her knowledge and belief and (h) affirm that neither they nor family members have violated the policy. The purpose of the policy is to ensure board members and covered persons are independent and able to perform their duties in an impartial manner, free from any bias created by personal interests, to protect the interests of MRC, to clarify the duties and obligations of the board members and covered persons in the context of a potential conflict (and to provide a method for disclosing and resolving said conflict) and to supplement (not replace) any applicable state laws governing conflicts of interest applicable to charitable, nonprofit corporations. MRC will not engage in any contract, transaction or arrangement involving a potential conflict of interest unless it is determined that appropriate safeguards protect the charitable mission of MRC have been implemented. The board's executive committee, working with the Swedish Health Services compliance officer, will review all conflict of interest questionnaires. The governance committee will make a finding as to whether an actual, apparent or potential conflict of interest exists and will forward that finding, along with recommendations for resolution, to the board for discussion and vote. For covered persons, the organization's conflict of interest committee works with the Swedish Health Services' compliance officer and follows a similar process. It reviews all questionnaires submitted by covered persons and communicates its findings and recommendations to be implemented by the appropriate committees. The minutes of meetings will identify any person attending the meeting who has a conflict of interest with respect to any matter before the board or committee and the action taken to address the conflict.
Form 990, Part VI, Section B, line 15
Compensation for the Executive Director is based upon the recommendation of an independent consultant. The independent consultant annually reviews market salaries and recommends a range based on fair market value. The recommendations of the consultant are reviewed and approved (or not approved) by the Executive Committee. The committee documents the basis for its decision. The Executive Director received an annual compensation review from the corporate Executive Committee during 2013.
Form 990, Part VI, Section C, line 19
Copies of the Marsha Rivkin Center's governing documents and financial statements are available upon request.
Form 990, Part IX, line 11g
Professional Fees Consultants: Program service expenses 30,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 30,000. Professional Fees Other: Program service expenses 47,232. Management and general expenses 0. Fundraising expenses 3,900. Total expenses 51,132. Purchased Services - Research Service: Program service expenses 313,520. Management and general expenses 0. Fundraising expenses 0. Total expenses 313,520.
Form 990, Part XI, line 9:
Prepaid 2014 Expense -13,000. Rounding 1.
Form 990, Part VI, Section B, Line 13 - WHISTLEBLOWER POLICY
Marsha Rivkin Center for Ovarian Cancer Research is subject to the written whistleblower policy of Swedish Health Services.
Form 990, Part VI, Section B, Line 14 - DOCUMENT RETENTION & DESTRUCTION
Marsha Rivkin Center for Ovarian Cancer Research is subject to the written document retention and destruction policy of Swedish Health Services.
FORM 990, PART I, LINE 6 - VOLUNTEERS
Family & Friends Auction Committee: Providing logistical assistance and strategic guidance to the production of special events including auction item procurement and audience development. The committee met monthly for six months prior to the event. The committee is lead by Rivkin Center staff (2) and event production contractors (3). Number of active volunteers in 2013 - 27 Office volunteers: The office volunteers at the Rivkin Center helped with general office duties including, but not limited to, filing, preparing mail correspondence, data input, and event preparation. Number of active office volunteers in 2013 - 4
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.