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
Healthcare Information and Management Systems Society Foundation
Employer identification number
36-4008359
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.") ....
350,155
371,829
399,539
238,097
393,519
1,753,139
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
350,155
371,829
399,539
238,097
393,519
1,753,139
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)..
583,362
6
Public support. Subtract line 5 from line 4.
1,169,777
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..
350,155
371,829
399,539
238,097
393,519
1,753,139
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
14,705
13,856
12,885
12,889
9,653
63,988
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.)..
3,158
3,158
11
Total support (Add lines 7 through 10).
1,820,285
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
64.260 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
59.300 %
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
Healthcare Information and Management Systems Society Foundation
Employer identification number
36-4008359
Return Reference
Explanation
Form 990, Part VI, Section A, line 1
The Standing Committees shall be the fund raising and scholarship committees and such other Standing Committees as the council may authorize by resolution. Standing Committee members shall be appointed for two year terms and divided into classes so approximately one-half of the members' terms expire each year. Standing Committee members are eligible for reappointment. Each standing committee shall have one member of the Governance Council appointed by the Governance Council Chair to serve as a liaison to that committee. Special Committees may be created or terminated at any time by resolution of the council. A Special Committee shall limit its activities to accomplishment of the tasks for which it is appointed and shall have no power to act except as specifically conferred by action of the council. Each Special Committee shall have one member of the Governance Council appointed by the Governance Council Chair to serve as a liaison to that committee. Upon completion of the tasks for which created, a special committee shall stand discharged.
Form 990, Part VI, Section B, line 11
A copy of the Form 990 is provided electronically to each voting member of the organization's governing body before it is filed. Voting members of the governing body then communicate with the Chief Financial Officer regarding the Form 990. The Governing Council of the organization reviews the Form 990 during a meeting of its members prior to the filing of the Form 990.
Form 990, Part VI, Section B, line 12c
Board members and key employees are annually required to complete a conflict of interest disclosure statement. The President/CEO reviews each statement of disclosure for any set of facts or circumstances that may reflect an actual, potential or apparent conflict of interest. The President/CEO may request the assistance of legal counsel to identify potential conflicts. If the President/CEO identifies an actual, potential, or apparent conflict of interest with respect to an officer, director, nominee for director, nominee for an elected position and/or nominee for appointment to the board, he/she must pursue resolution of such conflict of interest or challenge in accordance with Article 10, Section 10.3 of the HIMSS Bylaws. For the organization's employees, the President/CEO may take one of the following actions to resolve such conflict or challenge: (1) waive the conflict of interest as unlikely to affect disclosing party's ability to act in the best interests of the organization, (2) determine the disclosing party should be recused from all deliberation and decision-making related to the particular transaction or relationship that gives rise to the conflict of interest [this course of action should particularly apply when the transaction or relationship is one which presents a conflict only with respect to one or two discrete programs or activities], (3) recommend the disclosing party resign from his or her employment [this course of action should apply when the conflict is so pervasive the disclosing party would seldom, if ever, be able to act solely in the best interest of the organization].
Form 990, Part VI, Section B, line 15
HIMSS Foundation has no officers, directors, key employees or highest paid individuals that are compensated by the organization. There is an annual review process of HIMSS officers, directors, key employees and highest paid individuals. Some of the HIMSS compensated individuals that go through the compensation review process by HIMSS are on the board or are officers on HIMSS Foundation, but none are compensated by HIMSS Foundation.
Form 990, Part VI, Section C, line 19
The organization's Articles of Incorporation and Bylaws are available upon request. These documents are available per the disclosure guidelines of section 6104(d).
Form 990, Part VI, Line 17,
List of States receiving copy of Form 990: AL,AK,AZ,AR,CA,CO,CT,FL,GA,HI,IL,KS,KY,ME,MA,MI,MN,MS,NH,NJ,NM,N ,NC,ND,OH,OK,OR,PA,RI,SC,TN,UT,VA,WA,WV,WI
Form 990, Part IX, line 11g
IT Consulting: Program service expenses 257,879. Management and general expenses 0. Fundraising expenses 0. Total expenses 257,879.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.