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
Schepens Eye Research Institute Inc
Employer identification number
04-2129889
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.") ....
27,600,132
25,889,793
26,554,067
23,922,926
20,437,991
124,404,909
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
27,600,132
25,889,793
26,554,067
23,922,926
20,437,991
124,404,909
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)..
0
6
Public support. Subtract line 5 from line 4.
124,404,909
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..
27,600,132
25,889,793
26,554,067
23,922,926
20,437,991
124,404,909
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
778,104
831,091
506,619
620,995
972,710
3,709,519
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
458,249
582,303
428,192
1,468,744
11
Total support (Add lines 7 through 10).
129,583,172
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
96.004 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
96.156 %
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
Schepens Eye Research Institute Inc
Employer identification number
04-2129889
Return Reference
Explanation
Form 990, Part I, Line 1 & PART III, LINE 1
DESCRIPTION OF ORGANIZATION MISSION THE SCHEPENS EYE RESEARCH INSTITUTE ("SCHEPENS") FIGHTS BLINDNESS BY DEVELOPING NEW TECHNOLOGIES, THERAPIES AND KNOWLEDGE TO RETAIN AND RESTORE VISION. THROUGH A CONTINUUM OF DISCOVERY, THE INSTITUTE WORKS TOWARD A FUTURE IN WHICH BLINDNESS IS PREVENTED, ALLEVIATED AND ULTIMATELY CURED. Form 990, Part VI, Section A, line 6 The Foundation of the Massachusetts Eye and Ear Infirmary, Inc. is the sole member of the Institute. FORM 990, PART VI, SECTION A, LINE 7A The Board of Directors are elected by the Member. FORM 990, PART VI, SECTION A, LINE 7B The following actions shall require approval by the Member: 1. Approval of all long-term or master strategic or business plans of the Corporation and any substantive changes thereto; 2. Approval of any substantive changes to the vision and mission statement of the Corporation; 3. Approval of annual and long-term operating and capital budgets of the Corporation; 4. Approval of the merger, consolidation, or dissolution of the Corporation; 5. Approval of any material change in the types of research conducted by the Corporation, including additions thereto and discontinuations thereof, which are not expressly identified and provided for in the previously approved strategic and/or business plans; 6. Appointment or removal of financial auditors of the Corporation; 7. Approval of the Corporations plan of insurance; 8. Approval of the organization or acquisition of any subsidiary or affiliate of the Corporation, or the conducting of all or any part of the Corporations business through one or more affiliated corporations, partnerships, limited liability companies or other arrangements or entities; 9. Approval of any academic or other material strategic affiliation of the Corporation with third parties; Form 990, part VI, Section B, line 11B SCHEPENS'S FORM 990 IS PREPARED BY PRICEWATERHOUSECOOPERS, LLP USING INFORMATION PROVIDED BY MANAGEMENT. AFTER THE FORM 990 IS COMPLETED, IT IS REVIEWED BY THE DIRECTOR FINANCE OPERATIONS OF THE INFIRMARY. THE FORM 990 IS THEN PRESENTED TO THE FINANCE COMMITTEE FOR FURTHER REVIEW AND APPROVAL AS AUTHORIZED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS ALSO GIVEN THE FORM 990 FOR REVIEW WITH TIME TO SUBMIT COMMENTS AND QUESTIONS BEFORE FINAL FILING. FORM 990, Part VI, Section B, Line 12C ALL EMPLOYEES OF SCHEPENS ARE LEASED FROM THE INFIRMARY AND COVERED BY THE INFIRMARY CONFLICT OF INTEREST POLICY. MEMBERS OF THE STAFF ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST TO THEIR CHIEF OF SERVICE, DEPARTMENT AND DIRECTOR OF LABORATORY/UNIT. MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE ANNUALLY, IN WRITING, ANY INTERESTS THAT COULD RISE TO CONFLICTS. THE OFFICE OF THE INTERNAL LEGAL COUNSEL OBTAINS AND REVIEWS THE ANNUAL CONFLICTS OF INTEREST STATEMENTS SUBMITTED BY MEMBERS OF THE BOARD OF DIRECTORS, AND REPORTS ON THE SAME TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD. WITH RESPECT TO INTERESTS DISCLOSED BY THE BOARD MEMBERS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST, THE INTERNAL LEGAL COUNSEL REVIEWS ALL TRANSACTIONS BETWEEN SUCH INTERESTS AND AFFILIATES OF SCHEPENS, TO DETERMINE WHETHER THESE TRANSACTION WERE CONDUCTED AT ARM'S LENGTH. FORM 990, Part VI, Section B, Line 15 EMPLOYEES ARE LEASED FROM THE INFIRMARY. PLEASE SEE THE INFIRMARY'S RETURN FOR COMPENSATION DISCLOSURES. THE CHAIRMAN OF THE COMPENSATION COMMITTEE OF THE BOARD OF THE MASSACHUSETTS EYE AND EAR INFIRMARY PRESENTS A RECOMMENDATION TO THE COMPENSATION COMMITTEE WHO HAVE FINAL APPROVAL OF THE CEO'S BASE SALARY AND BONUS AMOUNT. THE CEO RECOMMENDS EXECUTIVE SALARIES TO THE COMPENSATION COMMITTEE OF THE BOARD WHO HAS FINAL AUTHORIZATION TO APPROVE IT. TOTAL COMPENSATION FOR THE CEO, CHIEFS AND VICE PRESIDENTS, INCLUDING BONUS PAYMENTS, INCLUDING COMPARABILITY DATA, IS ANALYZED BY INDEPENDENT COMPENSATION CONSULTANTS AND IS DETERMINED TO BE REASONABLE. FORM 990, PART VI, SECTION B, LINE 19 SUMMARIZED FINANCIAL STATEMENTS ARE AVAILABLE ON THE INFIRMARY'S WEBSITE: WWW.MASSEYEANDEAR.ORG. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. SCHEPENS' GOVERNING DOCUMENTS AND FORM 990 ARE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS ALSO AVAILABLE UPON REQUEST. FORM 990, Part VII COMPENSATION IS FOR PROFESSIONAL SERVICES AND NOT FOR SERVICE AS OFFICERS. SCHEPENS LEASES EMPLOYEES FROM THE INFIRMARY. PLEASE SEE THE INFIRMARY'S RETURN FOR COMPENSATION DISCLOSURES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.