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
THE JOHNS HOPKINS HOSPITAL
Employer identification number
52-0591656
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
THE JOHNS HOPKINS HOSPITAL
Employer identification number
52-0591656
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 7A
JOHNS HOPKINS HEALTH SYSTEM CORPORATION, A IRC 501(C)(3) TAX EXEMPT PARENT ORGANIZATION OF THE JOHNS HOPKINS HOSPITAL ELECTS THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION A, LINE 7B
THE GOVERNING BODY OF THE JOHNS HOPKINS HOSPITAL IS EMPOWERED BY ITS BY-LAWS TO MAKE CERTAIN DECISIONS; ALL OTHER DECISIONS ARE SUBJECT TO APPROVAL OF THE PARENT ORGANIZATION JOHNS HOPKINS HEALTH SYSTEM CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE FORM 990 IS SENT BY EMAIL TO THE ORGANZIATION'S GOVERNING BODY BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY IS A PART OF THE ANNUAL FINANCIAL AUDIT CONFIRMATION PROCESS PROVIDED ONLINE. ALL OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO COMPLY ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION B, LINE 15
EVERY THREE YEARS AN INDEPENDENT STUDY IS CONDUCTED GATHERING INDUSTRY COMPENSATION AVERAGES FROM SELECT PEER INSTITUTIONS. EVERY YEAR THE JOHNS HOPKINS BOARD OF TRUSTEES COMPENSATION COMMITTEE REVIEWS COMPENSATION AMOUNTS FOR OFFICERS AND ALL EMPLOYEES AT THE DIRECTOR AND HIGHER LEVELS.
FORM 990, PART VI, SECTION C, LINE 19
INTERNAL POLICIES, INCLUDING CONFLICT OF INTEREST POLICY, ARE PROVIDED TO THE PUBLIC ON THE ORGANIZATION'S WEBSITE. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, THE GOVERNING DOCUMENTS HAVE BEEN MADE AVAILABLE IN THE PUBLIC FILING WITH THE STATE OF MARYLAND AND THE INTERNAL REVENUE SERVICE.
FORM 990, PART XI, LINE 9:
MINIMUM PENSION LIABILITY -11,939,000. CHANGE IN MKT VAL. OF SWAP AGREEMENT -5,357,201. NET ASSETS RELEASED -3,121,155. NON-OPERATING SERVICES -7,112,000.
FORM 5471, SCHEDULE O, PART II, SECTION B (YEAR ENDING 12/31/13)
SCHEDULE O, PART II, SECTION B-U.S. PERSONS WHO ARE OFFICERS OR DIRECTORS OF THE FOREIGN CORP. NAME & ADDRESS SOCIAL SECURITY OFFICER DIRECTOR ----------------------------------------------------------------------- 1. MICHAEL C. GOONAN * X X 2. STEPHEN M. COHEN * X X 3. PHYLLIS R.F. LANTOS * X X 4. JAMES M. STATEN * X X 5. CHRISTOPHER D. SMITH * X 6. ABRAHAM P. CHEIJ, JR. * X 7. RONALD J. WERTHMAN * X X 8. FREDERICK G. SAVAGE, ESQ. * X 9. MARK LARMORE * X 10.RICHARD U. LEVINE, MD * X 11.DAVID J. LEFFELL * X 12.CHRISTOPHER GARROD, ESQ. * X X 13.MARK B. TAUBMAN * X * - DETAIL OF SOCIAL SECURITY NUMBER AND ADDRESS AVAILABLE UPON REQUEST
FORM 5471 - REGS SEC. 1.6046-1(B)(11) (YEAR ENDING 12/31/13)
STATEMENT REQUIRED PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(11) PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(11), THE MEDICAL CENTRE INSURANCE COMPANY, LTD. HAD THE FOLLOWING AMOUNTS OF INDEBTEDNESS: A. TO ANY UNITED STATES PERSON OWNING 5 PERCENT OR MORE IN VALUE OF THE COMPANY'S STOCK. NONE B. TO ANY OTHER FOREIGN CORPORATION OWNING 5 PERCENT OR MORE IN VALUE OF THE OUTSTANDING STOCK OF THE FOREIGN CORPORATION. NONE STATEMENT REQUIRED PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(12) PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(12), THE FOLLOWING IS A COMPLETE LIST OF ALL SUBSCRIBERS TO THE STOCK OF THE MEDICAL CENTRE INSURANCE COMPANY, LTD. AS OF DECEMBER 31, 2013: NONE
FORM 5471, SCHEDULE O, PART II, SECTION B (YEAR ENDING 4/30/14)
SCHEDULE O, PART II, SECTION B-U.S. PERSONS WHO ARE OFFICERS OR DIRECTORS OF THE FOREIGN CORP. NAME & ADDRESS SOCIAL SECURITY OFFICER DIRECTOR ----------------------------------------------------------------------- 1. MICHAEL C. GOONAN * X X 2. STEPHEN M. COHEN * X X 3. PHYLLIS R.F. LANTOS * X X 4. JAMES M. STATEN * X X 5. CHRISTOPHER D. SMITH * X 6. ABRAHAM P. CHEIJ, JR. * X 7. RONALD J. WERTHMAN * X X 8. FREDERICK G. SAVAGE, ESQ. * X 9. MARK LARMORE * X 10.RICHARD U. LEVINE, MD * X 11.DAVID J. LEFFELL * X 12.CHRISTOPHER GARROD, ESQ. * X X 13.MARK B. TAUBMAN * X * - DETAIL OF SOCIAL SECURITY NUMBER AND ADDRESS AVAILABLE UPON REQUEST
FORM 5471 - REGS SEC. 1.6046-1(B)(11) (YEAR ENDING 4/30/14)
STATEMENT REQUIRED PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(11) PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(11), THE MEDICAL CENTRE INSURANCE COMPANY, LTD. HAD THE FOLLOWING AMOUNTS OF INDEBTEDNESS: A. TO ANY UNITED STATES PERSON OWNING 5 PERCENT OR MORE IN VALUE OF THE COMPANY'S STOCK. NONE B. TO ANY OTHER FOREIGN CORPORATION OWNING 5 PERCENT OR MORE IN VALUE OF THE OUTSTANDING STOCK OF THE FOREIGN CORPORATION. NONE STATEMENT REQUIRED PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(12) PURSUANT TO TREASURY REGULATION SECTION 1.6046-1(B)(12), THE FOLLOWING IS A COMPLETE LIST OF ALL SUBSCRIBERS TO THE STOCK OF THE MEDICAL CENTRE INSURANCE COMPANY, LTD. AS OF APRIL 30, 2014: NONE
FORM 5471 - REGS SEC. 1.368-3(B) (YEAR ENDING 4/30/14)
STATEMENT PURSUANT TO TREASURY REGULATION SECTION 1.368-3(B) BY THE JOHNS HOPKINS HOSPITAL - EIN 52-0591656, A SIGNIFICANT HOLDER. THE NAME AND EMPLOYER IDENTIFICATION NUMBER OF EACH OF MCIC VERMONT HOLDINGS, INC. 03-0356599 AND MCIC VERMONT, INC. 03-0354178 THE DATE OF THE DOWNSTREAM MERGER - 5-1-14 THE FAIR MARKET VALUE $1,052,220, DETERMINED IMMEDIATELY BEFORE THE DOWNSTREAM MERGER, OF THE STOCK OF MCIC VERMONT HOLDINGS, INC., THAT THE SHAREHOLDER TRANSFERRED IN THAT TRANSACTION; AND THE SHAREHOLDER'S TAX BASIS $1,000,000, DETERMINED IMMEDIATELY BEFORE THE DOWNSTREAM MERGER, IN THE STOCK OF MCIC VERMONT HOLDINGS, INC., THAT THE SHAREHOLDER TRANSFERRED IN THAT TRANSACTION.
FORM 5471 - REGS SEC. 1.368-3(A) (YEAR ENDING 4/30/14)
STATEMENT PURSUANT TO TREASURY REGULATION SECTION 1.368-3(A) BY THE JOHNS HOPKINS HOSPITAL - EIN 52-0591656, A CORPORATION, A SIGNIFICANT HOLDER. THE NAME AND EMPLOYER IDENTIFICATION NUMBER OF EACH OF THE MEDICAL CENTRE INSURANCE COMPANY, 98-0101472 AND MCIC VERMONT, INC. 03-0354178 THE DATE OF THE MEDICAL CENTRE INSURANCE COMPANY MERGER 5-1-14 THE AGGREGATE FAIR MARKET VALUE $1,713,005,983, DETERMINED IMMEDIATELY BEFORE THE MEDICAL CENTRE INSURANCE COMPANY MERGER, OF THE ASSETS OF THE MEDICAL CENTRE INSURANCE COMPANY THAT ARE TRANSFERRED TO MCIC VERMONT, INC. IN THAT TRANSACTION. THE AGGREGATE TAX BASIS $1,721,580,518, DETERMINED IMMEDIATELY BEFORE THE MEDICAL CENTRE INSURANCE COMPANY MERGER, OF THE ASSETS OF THE MEDICAL CENTRE INSURANCE COMPANY THAT ARE TRANSFERRED TO MCIC VERMONT, INC., IN THAT TRANSACTION.
FORM 5471 - SECTION 367(B) NOTICE (YEAR ENDING 4/30/14)
MEDICAL CENTRE INSURANCE COMPANY MERGER IS A SECTION 367(B) EXCHANGE; THE MEDICAL CENTRE INSURANCE COMPANY MERGED INTO MCIC VERMONT, INC., WITH THE FORMER SHAREHOLDERS OF THE MEDICAL CENTRE INSURANCE COMPANY DEEMED TO RECEIVE THE STOCK OF MCIC VERMONT, INC. IN THE TRANSACTION; AND $0 REQUIRED TO BE TAKEN INTO ACCOUNT AS INCOME BY THE SHAREHOLDER UNDER SECTION 367(B) AND THE TREASURY REGULATIONS PROMULGATED THEREUNDER AS A RESULT OF THE MEDICAL CENTRE INSURANCE COMPANY MERGER.
FORM 5471 - REGS SEC. 1.368-3(B) (YEAR ENDING 4/30/14)
STATEMENT PURSUANT TO TREASURY REGULATION SECTION 1.368-3(B) BY THE JOHNS HOPKINS HOSPITAL - EIN 52-0591656, A SIGNIFICANT HOLDER. THE NAME AND EMPLOYER IDENTIFICATION NUMBER OF MCIC VERMONT, INC. 03-0354178; THE DATE OF THE CONVERSION 5-1-14; AND THE BASIS $58,358,437 AND FAIR MARKET VALUE $77,763,020 OF THEIR EQUITY INTEREST IN MCIC VERMONT, INC. IMMEDIATELY BEFORE THE CONVERSION.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.