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
UNIVERSITY MEDICAL GROUP
Employer identification number
93-0608012
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(A)
OREGON HEALTH & SCIENCE UNIVERSITY
931176109
06
Yes
14,348,506
Total
14,348,506
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
UNIVERSITY MEDICAL GROUP
Employer identification number
93-0608012
Return Reference
Explanation
PROCESS TO REVIEW FORM 990
FORM 990 PART VI LINE 11B AN OUTSIDE ACCOUNTING FIRM PREPARED THE FEDERAL FORM 990. THE CONTROLLER AND THE CHIEF EXECUTIVE OFFICER (CEO) OF UNIVERSITY MEDICAL GROUP (UMG) REVIEW THE FORM 990. THE CEO REPORTS THE ORGANIZATION'S OPERATING AND FINANCIAL RESULTS TO THE UMG BOARD OF DIRECTORS. THE FEDERAL FORM 990 IS ALSO PROVIDED TO THE UMG BOARD OF DIRECTORS PRIOR TO FILING.
CONFLICT OF INTEREST DISCLOSURE
FORM 990 PART VI LINE 12C AN INSTITUTIONAL CONFLICT OF INTEREST (ICOI) MAY EXIST WHEN UMG BOARD OF DIRECTOR MEMBERS OR EXECUTIVES HAVE EXTERNAL RELATIONSHIPS OR FINANCIAL INTEREST (HEREINAFTER DEFINED AS "SIGNIFICANT FINANCIAL INTERESTS") IN A COMPANY OR ORGANIZATION THAT HAS SIGNIFICANT BUSINESS TRANSACTIONS WITH THE ORGANIZATION. THESE DUAL RELATIONSHIPS MAY INTERFERE, OR APPEAR TO INTERFERE, WITH THE OBLIGATION TO ACT IN THE ORGANIZATION'S BEST INTEREST. BECAUSE THE APPEARANCE OF A CONFLICT MAY BE AS DAMAGING TO THE PUBLIC TRUST AS AN ACTUAL CONFLICT, POTENTIAL CONFLICTS MUST BE DISCLOSED, EVALUATED, AND MANAGED WITH THE SAME THOROUGHNESS AS ACTUAL CONFLICTS. THE INTEGRITY PROGRAM OVERSIGHT COUNCIL (IPOC) IS THE BOARD-DESIGNATED BODY TO REVIEW POTENTIAL ICOI'S AS DESCRIBED ABOVE. POTENTIAL ICOI'S WILL BE IDENTIFIED THROUGH THE EXECUTIVE AND BOARD MEMBER CONFLICT OF INTEREST DISCLOSURES AND OTHER SOURCES. THIS POLICY APPLIES TO ALL UMG BOARD OF DIRECTORS MEMBERS AND UMG EXECUTIVES. UMG BOARD OF DIRECTORS MEMBERS AND UMG EXECUTIVES SHALL DISCLOSE TO THE IPOC ANNUALLY, ON A FORM APPROVED BY THE IPOC, RELATIONSHIPS AND CIRCUMSTANCES THAT COULD, TO THE BEST OF THE EXECUTIVE'S KNOWLEGE, POSE A POTENTIAL OR ACTUAL CONFLICT OF INTEREST UNDER THIS POLICY. IF THE IPOC BELIEVES A DISCLOSURE POSES A POTENTIAL OR ACTUAL CONFLICT, IT SHALL INDICATE TO THE UMG BOARD OF DIRECTORS MEMBER OR UMG EXECUTIVE HOW TO DISPOSE OF OR MANAGE THE CONFLICT. DISCLOSURES ARE DUE ANNUALLY. IF THE RESPONSES TO ANY OF THE QUESTIONS CHANGE DURING THE YEAR, THE DISCLOSURE FORM MUST BE REVISED AND RESUBMITTED. ANY REAL OR APPARENT ICOI MUST BE REVIEWED BY THE IPOC, WHICH MAY IMPOSE MANAGEMENT CONDITIONS INCLUDING, BUT NOT LIMITED TO: A. ENSURING THAT INSTITUTIONAL FINANCIAL INTERESTS AND INVESTMENTS ARE BEING MANAGED BY INDIVIDUALS/DEPARTMENTS THAT ARE NOT INVOLVED IN PURCHASING, PROCUREMENT, CONTRACTING, RESEARCH, OR OTHER OPERATIONS DECISIONS AND OVERSIGHT; B. REQUIRING PUBLIC DISCLOSURE OF THE INSTITUTIONAL COI IN PUBLICATIONS, PRESENTATIONS, OR OTHER PUBLIC ANNOUNCEMENTS; C. IMPOSING AN ESCROW PERIOD FOR REALIZING A FINANCIAL GAIN ("CASHING OUT"); D. DIVESTING THE FINANCIAL INTEREST; E. REASSIGNING, REMOVING, OR OTHERWISE MAKING A FIREWALL FOR EXECUTIVES WHO MAY BE CONFLICTED OR PERCEIVED AS NOT HAVING "CLEAN HANDS" FOR ANY BUSINESS DECISIONS OR ACTIVITIES INVOLVING ANY ENTITY WITH WHICH THE EXECUTIVE HAS A SIGNIFICANT FINANCIAL INTEREST; F. NOTIFICATION TO A DONOR THAT GIFTS TO UMG WILL NOT BE TAKEN INTO ACCOUNT FOR FUTURE BUSINESS RELATIONSHIPS, OR REFUSAL OR RETURN OF GIFTS, ENTERTAINMENT, OR OTHER PREREQUISITES FROM AN ENTITY THAT HAS A BUSINESS RELATIONSHIP WITH UMG OR IN WHICH UMG AND/OR AN EXECUTIVE HAS AN INVESTMENT; AND/OR G. OTHER MANAGEMENT PLANS THAT THE IPOC MAY DESIGN. ICOI MANAGEMENT IS IN ADDITION TO ANY MANAGEMENT THAT MIGHT APPLY FOR INDIVIDUAL CONFLICTS OF INTEREST.
PROCESS TO DETERMINE COMPENSATION
FORM 990 PART VI, LINE 15A & 15B THE COMPENSATION FOR THE UNIVERSITY MEDICAL GROUP COO, ALSO SERVING AS THE OHSU DIRECTOR OF ENTERPRISE REVENUE CYCLE, WAS DERIVED BY DATA GATHERED FROM THE AMERICAN ASSOCIATION OF MEDICAL COLLEGES (AAMC) - APPD ANNUAL SALARY SURVEY. ALONG WITH MBL GROUP, A COMPENSATION CONSULTANCY, UTILIZING THEIR LARGER DATABASES AND OTHER SOURCES, THE UMG CEO AND OHSU HOSPITAL CFO DETERMINED THE BASE PAY LEVEL. FOR INCENTIVE COMPENSATION, FORMULAIC COMPONENTS CONSISTENT WITH THE OHSU MANAGEMENT INCENTIVE PROGRAM (MIP) WERE USED TO DEFINE THE BONUS AMOUNT BASED UPON THE ROLLUP OF VARIOUS REVENUE CYCLE PERFORMANCE GOALS ACROSS BOTH UMG AND OHSU. THE CEO AND HOSPITAL CFO PRESENTED THE PERFORMANCE EVALUATION, BONUS GOAL RESULTS AND A BASE COMPENSATION & BONUS PROPOSAL TO THE DEAN OF THE OHSU SCHOOL OF MEDICINE AND THE OHSU EXECUTIVE VICE PRESIDENT FOR THEIR COLLECTIVE APPROVAL. THE COMPENSATION FOR THE UNIVERSITY MEDICAL GROUP CEO, WHO ALSO HOLDS THE POSITION OF OHSU SENIOR ASSOCIATED DEAN, IS BASED ON THE TIME ALLOCATED TO EFFORTS DEVOTED TO THE UNIVERSITY MEDICAL GROUP REVENUE CYCLE. AS OF JANUARY 2009, IT WAS DETERMINED THAT THIS EFFORT REPRESENTED APPROXIMATELY 10% OF TOTAL TIME SPENT. COMPENSATION FROM UNIVERSITY MEDICAL GROUP REMAINS FIXED BASED UP ON THIS PERCENTAGE OF HIS OHSU BASE COMPENSATION AT THAT TIME.
OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE
FORM 990 PART VI LINE 19 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION, UNIVERSITY MEDICAL GROUP WILL PROVIDE THESE DOCUMENTS UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.