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
SWEDISH MEDICAL CENTER FOUNDATION
Employer identification number
91-0983214
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.") ....
19,116,401
20,299,923
21,139,529
18,209,026
16,570,203
95,335,082
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
19,116,401
20,299,923
21,139,529
18,209,026
16,570,203
95,335,082
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)..
6,249,265
6
Public support. Subtract line 5 from line 4.
89,085,817
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..
19,116,401
20,299,923
21,139,529
18,209,026
16,570,203
95,335,082
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,205,741
482,559
831,917
142,969
29,816
2,693,002
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).
98,028,084
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
90.880 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
89.290 %
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
SWEDISH MEDICAL CENTER FOUNDATION
Employer identification number
91-0983214
Return Reference
Explanation
Form 990, Part VI, Section A, line 6
Swedish Health Services is the sole member of Swedish Medical Center Foundation.
Form 990, Part VI, Section A, line 7a
Election of members of the Board of governors is subject to the approval of Swedish Health Services.
Form 990, Part VI, Section A, line 7b
The following decisions by the governing body are subject to approval by Swedish Health Services, the sole member Swedish Medical Center Foundation: A. Appointment of the Chair and Vice-Chair. B. Delegation of the power or duties of an officer or administrator to any other officer or any director or other person. C. The filling of vacancies in the office of Chair or Vice-Chair. D. The appointment of other officers or agents appointed to exercise powers and duties on behalf of the Board of governors. E. The Chair or Vice-Chair may be removed at any time, with or without cause, by the affirmative vote of a majority of the whole board of governors or by the member. F. The bank or banks, trust company or trust companies holding the moneys of the corporation. G. The process for withdrawal of the moneys of the corporation. H. Additions, alterations, amendment, repeal of bylaws.
Form 990, Part VI, Section B, line 11
The Form 990 is prepared internally by experienced Swedish accounting staff and reviewed by the Director of Taxes of Providence Health & Services and external tax advisors. The Foundation President and signing Board Officer 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 12c
The Swedish Medical Center Foundation is subject to the conflict of interest policy of Swedish Health Services, its sole member. Management employees are covered by the Swedish Health Services conflict of interest policy. 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 to the appropriate committee chair any further financial interest, situation, activity, interest or conduct that may develop before completion of the next annual questionnaire. Potential conflicts of interest with physician board members with financial interests in businesses that compete with the foundation are addressed, as well as appropriate disclosures, evaluation and resolution of said conflicts. 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 the organization is a charitable organization that must engage primarily in exempt activities, (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. 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 the foundation, 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, non-profit corporations. Swedish Medical Center Foundation 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 the Foundation have been implemented. The Executive committee of Swedish Health Services will review all conflict of interest questionnaires for board members. The Executive committee will make a finding as to whether an actual, apparent or potential conflict of interest exists and will take actions as it deems appropriate. The conflict of interest committee governs the policy and questionnaire related to all other covered persons. 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 of interest (e.g., the individual left the room during the discussion of the matter giving rise to the conflict of interest and the individual did not vote on such matter).
Form 990, Part VI, Section B, line 15
The Board of governors has delegated authority to the compensation and HR committees of the Swedish Health Services board of trustees to review and approve compensation arrangements for the President of the Foundation. All members of the compensation and HR committees are independent. Swedish Health Services is the sole member of Swedish Medical Center Foundation. Compensation for executives is reasonable and consistent with the executive total compensation philosophy approved by the board of trustees. Potential conflicts of interest are addressed in accordance with the corporation's conflict of interest policy. The Board of trustees selects and retains an independent consultant to conduct an annual review of the compensation package, including salaries, incentives and benefits and recommend appropriate adjustments to ensure that each remains competitive and responsive to changing laws and in keeping with the organization's mission. The Board, as part of its analysis, obtains from the independent consultant appropriate comparability data, including total compensation paid by similarly situated for profit and not for profit healthcare organizations for positions that are functionally comparable. The consultant provides documentation that total compensation is at fair market value. The consultants' recommendations are reviewed and approved (or not approved) by the compensation and HR committees, which document the basis for their decision. Following approval of the annual review by the compensation and HR committees, the CEO of Swedish Health Services will approve changes in the compensation package for the President consistent with the annual review and recommendations approved by the compensation and HR committee. Salaries for non-executive employees are reviewed and approved by HR.
Form 990, Part VI, Section C, line 19
Copies of the Swedish Medical Center Foundation's governing documents, conflict of interest policy and financial statements are available upon request.
Form 990, Part XI, line 9:
Prepaid 2014 Deposit -5,000.
Form 990, Part VI, Section B, Line 13
The Swedish Medical Center Foundation is subject to the written whistleblower policy of its sole member, Swedish Health Services.
Form 990, Part VI, Section B, Line 14
The Swedish Medical Center Foundation is subject to the written document retention and destruction policy of its sole member, Swedish Health Services.
FORM 990, PART XII, LINE 2c - AUDIT & COMPLIANCE
The Audit and Compliance Committee assists the Board of Directors with the oversight of the integrity of the financial statements and reporting, the audit process and the internal financial controls and policies; compliance with ethical, legal and regulatory standards and requirements; the independence, qualifications and performance of the internal and external auditors; the investment committee; and informs the Board of Directors of critical risk areas and recommended mitigation.
EXPLANATION OF AMENDED FORM 990
The original Form 990 was filed prior to the release of the final 2013 Audited Financial Statements for the Foundation. The amended return is being filed to report all revenues, expenses and balance sheet accounts in accordance with the Audited Financial Statements issued.
FORM 990, PART VII, SECTION A - COMPENSATION
Employees working at the Foundation are compensated by related organizations. Therefore, no W-2s are issued by the reporting organization. Physicians serving on the Board are compensated by the related organization for their services to the medical facilities and not for their role as a trustee on the Foundation Board. Don Theophilus's salary as President of the Foundation is paid by Providence Health & Services - WA. The remaining persons listed on Part VII are not compensated for serving as trustees or officers of the Swedish Medical Center Foundation.
FORM 990, PART I, LINE 6 - VOLUNTEERS
The Art Committee The Art Committee provides curatorial management of the Swedish Health Services (SHS) art collection, implements SHS policies regarding art, coordinates the orderly distribution of art resources throughout SHS, seeks donations of art, and acts as the final arbiter on issues regarding art. Volunteers - 11 members on the committee (plus 4 Swedish staff members) Swedish Issaquah Community Giving Council (ICGC) The ICGC provides guidance in the development of meaningful programs and services at Swedish/Issaquah which the community can support. Volunteers - 19 Swedish Brain Cancer Walk (SBCW) Planning Committee The SBCW Planning Committee consists of members responsible for the following Walk activities; fundraising, Tent of Honor, Patient & Survivor Tent and Walk Day Entertainment. The committee meets monthly for 6 months prior to the Walk. Volunteers - 24 Swedish Women & Infants and Pediatrics Development Council Supporting and providing guidance for strategic initiatives with the service lines of Women & Infants and Pediatrics at Swedish Medical Center, helping to improve patient care, supporting caregivers in their work, generating public awareness, and raising funds from the community to support the Swedish Medical Center mission. Volunteers - 14 (plus 6 Swedish staff members) Celebrate Swedish Planning Committee The CS Planning Committee assists with auction procurement, in-kind donations and event production for the 2014 Celebrate Swedish Gala. The committee meets monthly for eight months prior to the event. Volunteers - 20 Destination Swedish Committee Committee meets monthly to work on the program, audience development and the guest experience. Volunteers - 23 2013 Swedish/Edmonds Imagine Gala Planning Committee Committee assists with auction procurement, in kind donations and event production for the 2013 Imagine Gala. Swedish Medical Center Foundation event manager will work closely with committee to support and achieve goals. Volunteers - 10 Other The office volunteers at the Foundation work on a variety of administrative tasks and special projects for the Foundation. Volunteers - 3
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.