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
EL PASO CHILDREN'S HOSPITAL CORPORATION
Employer identification number
26-3075429
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
EL PASO CHILDREN'S HOSPITAL CORPORATION
Employer identification number
26-3075429
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
EL PASO CHILDREN'S HOSPITAL ENGAGES AN INDEPENDENT ACCOUNTING FIRM EXPERIENCED IN THE PREPARATION OF THE FORM 990 TO PREPARE ITS FORM 990. THE ORGANIZATION'S FINANCE AND LEGAL DEPARTMENTS REVIEW THE 990. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS, THE CHIEF EXECUTIVE OFFICER, THE CHIEF FINANCIAL OFFICER, THE CONTROLLER, AND THE ACCOUNTING MANAGER FOR REVIEW, CHANGES, AND APPROVAL PRIOR TO FILING FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C
EPCH LEADERS AND MEMBERS OF THE MEDICAL STAFF SIGN A CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY (ATTACHMENT 1) ANNUALLY, CERTIFYING THAT THEY RECEIVED, READ, AND UNDERSTOOD THIS CONFLICT OF INTEREST POLICY AND AGREE TO COMPLY WITH IT. EPCH LEADERS OBTAIN THE CERTIFICATION FORM FROM THE COMPLIANCE OFFICE. ANNUALLY, THE COMPLIANCE OFFICER PROVIDES NOTIFICATION TO EPCH LEADERS TO COMPLETE THE FORM. IT IS THE EPCH LEADERS' RESPONSIBILITY TO RETURN THE SIGNED FORM TO THE COMPLIANCE OFFICE NO LATER THAN THE SEVENTH (7TH) BUSINESS DAY UPON NOTIFICATION FROM THE COMPLIANCE OFFICER AS STATED ABOVE. FAILURE TO RETURN THE FORM TO THE COMPLIANCE OFFICE SHALL CAUSE THE EPCH LEADER TO BE IN VIOLATION OF THIS POLICY. MEMBERS OF THE MEDICAL STAFF OBTAIN THE CERTIFICATION FORM FROM MEDICAL STAFF SERVICES AT THE TIME OF INITIAL CREDENTIALING AND RECREDENTIALING. IT IS THE MEDICAL STAFF MEMBERS RESPONSIBILITY TO RETURN THE SIGNED FORM TO MEDICAL STAFF SERVICES IN A TIMELY MANNER. MEDICAL STAFF MEMBERS WILL NOT BE (RE)CREDENTIALED IN THE ABSENCE OF A SIGNED CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY. EACH TIME A PROCUREMENT PROCESS IS INITIATED AND A COMMITTEE IS INVOLVED IN MAKING A DECISION OR RECOMMENDATION ON A BUSINESS RELATIONSHIP, A CONFLICT OF INTEREST CERTIFICATION STATEMENT MUST BE COMPLETED BY THOSE COMMITTEE MEMBERS WHO HAVE NOT PREVIOUSLY COMPLETED THE ANNUAL CERTIFICATION. THE COMPLIANCE OFFICE MAINTAINS THE FILE OF THE ANNUAL CERTIFICATION FORMS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF, AND ALL MATERIAL FACTS CONCERNING HIS OR HER FINANCIAL/PERSONAL INTEREST TO THE COMPLIANCE OFFICER WITHIN SEVEN (7) BUSINESS DAYS OF IDENTIFYING THE ACTUAL OR POTENTIAL CONFLICT. SUCH DISCLOSURE WILL BE MADE IN WRITING BY SUBMITTING A HOSPITAL CONFLICT OF INTEREST CERTIFICATION AND ACKNOWLEDGEMENT OF CONFLICT OF INTEREST POLICY FORM. OUTSIDE INTERESTS SHALL BE DISCLOSED AS A POTENTIAL CONFLICT OF INTEREST WHEN EPCH LEADERS RECEIVE MONIES FOR DUTIES PERFORMED AT ENTITIES WITH THE SAME OR SIMILAR SERVICE OFFERED AND IN A GEOGRAPHIC LOCATION SERVING THE SAME COMMUNITY. THE COMPLIANCE OFFICER REVIEWS WITH THE CEO AND GENERAL COUNSEL ANY CONFLICT OF INTEREST CERTIFICATION FORMS THAT IDENTIFY POTENTIAL CONFLICTS. THE COMPLIANCE OFFICER MAY ASK THE INTERESTED PERSON TO DISCUSS THE PROPOSED TRANSACTION IN ORDER TO OBTAIN FURTHER DETAILS. THE COMPLIANCE OFFICER MAY, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO ANY PROPOSED TRANSACTION OR ARRANGEMENT AND DETERMINES WHETHER THE HOSPITAL CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. THE COMPLIANCE OFFICER PROVIDES QUARTERLY REPORTS TO THE BOARD OF DIRECTORS DETAILING CONFLICTS OF INTEREST AND HOW THEY WERE ADDRESSED. WITH RESPECT TO RESEARCH CONFLICTS OF INTEREST, EPCH REQUIRES THAT A RESEARCH INVESTIGATOR DISCLOSE TO EPCH OUTSIDE FINANCIAL INTERESTS ABOVE SPECIFIED THRESHOLDS WHEN RESEARCH WOULD LIKELY BE AFFECTED BY THOSE INTERESTS. EPCH THEN REVIEWS THE DISCLOSURES, DETERMINES WHETHER THERE IS A CONFLICT AND, IF SO, MANAGES, REDUCES, OR ELIMINATES IT, BEFORE ALLOWING PARTICIPATION IN THE PROPOSED RESEARCH PROJECT. UPON DISCOVERY OF A POTENTIAL CONFLICT OF INTEREST THAT HAS NOT BEEN DISCLOSED, THE EPCH LEADER/MEDICAL STAFF MEMBER IS NOTIFIED BY THE COMPLIANCE OFFICER AND AFFORDED THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER REVIEWING THE RESPONSE AND MAKING SUCH FURTHER INVESTIGATION AS APPROPRIATE, THE COMPLIANCE OFFICER SHALL INFORM THE CEO OF THE DETERMINATION WHETHER THE EPCH LEADER/MEDICAL STAFF MEMBER FAILED TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. ANY VIOLATIONS OF THIS POLICY MAY BE GROUNDS FOR DISCIPLINARY ACTION INCLUDING TERMINATION OF EMPLOYMENT OR HOSPITAL CREDENTIALS, AND FOR CIVIL OR CRIMINAL PROSECUTION.
FORM 990, PART VI, SECTION B, LINE 15
EL PASO CHILDREN'S HOSPITAL DETERMINES COMPENSATION FOR ITS CEO AND OTHER OFFICERS AND KEY EMPLOYEES BY CONSIDERING SALARY RANGES, SALARY SURVEYS, AND MARKET ANALYSES FOR EACH POSITION. SPECIFICALLY, THE BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS AND RECOMMENDS SALARIES FOR THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE BOARD OF DIRECTORS APPROVES SALARIES FOR THE CEO AND OTHER OFFICERS. THE CEO APPROVES SALARIES FOR KEY EMPLOYEES (DIRECTOR LEVEL AND BELOW).
FORM 990, PART VI, SECTION C, LINE 19
PART VI, SECTION C, LINE 19: THE ORGANIZATION FURNISHES COPIES OF ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, FORM 990, AND/OR FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST. ADDITIONALLY, FORMS 990 WILL BE PUBLISHED ON THE ORGANIZATION'S WEBSITE.
FORM 990, PART IX, LINE 11G
PROFESSONAL FEES: PROGRAM SERVICE EXPENSES 16,169,762. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,169,762.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.