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
UTMB HEALTHCARE SYSTEMS INC
Employer identification number
76-0682238
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)
UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
746000949
06
Yes
Yes
Yes
1,597,995
Total
1,597,995
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
UTMB HEALTHCARE SYSTEMS INC
Employer identification number
76-0682238
Return Reference
Explanation
PART V, 14B
INDOOR TANNING SERVICES THE ORGANIZATION DOES NOT HAVE INDOOR TANNING SERVICES.
PART VI, SECTION B, 11B
FORM 990 REVIEW PROCEDURES THE FORM 990 IS REVIEWED BY THE CEO PRIOR TO BEING SIGNED.
PART VI, SECTION B, 12C
MONITORING OF CONFLICTS OF INTEREST THE CORPORATE SECRETARY REVIEWS THE ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE RESPONSES. UTMB'S OFFICE OF INSTITUTIONAL COMPLIANCE REGULARLY MONITORS CONFLICTS OF INTEREST, AND UTMB'S INTERNAL AUDIT DEPARTMENT PERIODICALLY VALIDATES THEIR ACTIVITIES. TO DATE THERE HAVE BEEN NO CONFLICTS OF INTEREST.
PART VI, SECTION B, 15A
EXECUTIVE COMPENSATION THE CEO RECEIVES NO COMPENSATION FROM UTMB HEALTHCARE SYSTEMS, INC. HE IS COMPENSATED BY THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. HIS SALARY WAS DETERMINED FROM A REVIEW DONE BY AN INDEPENDENT CONSULTANT AND HE HAS A WRITTEN CONTRACT WITH UTMB IN WHICH HIS SALARY IS STATED.
PART VI, SECTION B, 15B
OFFICER COMPENSATION OTHER OFFICERS RECEIVE NO COMPENSATION FROM UTMB HEALTHCARE SYSTEMS, INC. THEY ARE COMPENSATED BY THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON.
PART VI, SECTION C, 19
PUBLIC INSPECTION OF DOCUMENTS THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST ONLY.
BUSINESS RELATIONSHIPS
THE FOLLOWING OFFICERS AND DIRECTORS HAVE A BUSINESS RELATIONSHIP WITH THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON (EIN 74-6000949): DAVID L. CALLENDER, M.D. DAVID M. CONNAUGHTON DANNY O. JACOBS, M.D. BEN RAIMER, M.D. REX MCCALLUM, M.D. DONNA K. SOLLENBERGER SANDRA Y. BENIGAR OFFICER RELATIONSHIPS THE FOLLOWING OFFICERS AND DIRECTORS HAVE A COMMON BOARD MEMBERHIP WITH UTMB HEALTH PLANS, INC. (EIN 76-0480012): DAVID L. CALLENDER, M.D. DAVID M. CONNAUGHTON DANNY O. JACOBS, M.D. BEN RAIMER, M.D. SANDRA Y. BENIGAR THE FOLLOWING OFFICERS AND DIRECTORS HAVE A COMMON BOARD MEMBERSHIP WITH FHC FAMILY HEALTHCARE CENTERS, INC. (EIN 76-0697230): DAVID L. CALLENDER, M.D. DAVID M. CONNAUGHTON DANNY O. JACOBS, M.D. BEN RAIMER, M.D. REX MCCALLUM, M.D. SANDRA Y. BENIGAR THE FOLLOWING OFFICERS AND DIRECTORS HAVE A COMMON BOARD MEMBERSHIP WITH HSI HEALTHCARE SERVICES (EIN: 76-0632955): DAVID L. CALLENDER, M.D. DAVID M. CONNAUGHTON DANNY O. JACOBS, M.D. DONNA K. SOLLENBERGER SANDRA Y. BENIGAR
PART I, 1 AND PART III, 1
ORGANIZATION'S MISSION THE MISSION OF UTMB HEALTHCARE SYSTEMS, INC. (UTMB HCS) IS TO IMPROVE THE HEALTH OF TEXAS COMMUNITIES BY CREATING A NETWORK OF HEALTH CARE PROFESSIONALS ENGAGING IN STATE-OF-THE-ART PATIENT CARE, SCHOLARLY MEDICAL EDUCATION, AND INNOVATIVE RESEARCH.
PART V, 2A
EMPLOYEE COMPENSATION ALL COMPENSATION IS PAID BY THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON. (EIN 74-6000949)
PART VIII, 2A AND PART IX, LINE 7
MANAGEMENT SERVICES REVENUE AND OTHER SALARIES AND WAGES IN FY14, UTMB HEALTHCARE SYSTEMS, INC. BEGAN EXPENSING PERFUSIONIST, TEMPORARY EMPLOYMENT, AND SALARIES AND BENEFITS COSTS IN ORDER TO MORE ACCURATELY REFLECT THE TOTAL REVENUE AND EXPENSES OF UTMB HEALTHCARE SYSTEMS, INC. THIS CHANGE, WHILE NOT IMPACTING NET INCOME, DID RESULT IN A DRAMATIC INCREASE IN EXPENSES AND OFFSETTING REVENUE REPORTED. THESE ITEMS WERE PREVIOUSLY ONLY REPORTED ON THE BALANCE SHEET AS RECEIVABLES FROM THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON AND PAYABLES TO THE INDEPENDENT CONTRACTORS.
PART VIII, 2A AND PART IX, 11G
MANAGEMENT SERVICES REVENUE AND FEES FOR SERVICES (NON-EMPLOYEES) IN FY14, UTMB HEALTHCARE SYSTEMS, INC. BEGAN EXPENSING PERFUSIONIST AND TEMPORARY EMPLOYMENT COSTS IN ORDER TO MORE ACCURATELY REFLECT THE TOTAL REVENUE AND EXPENSES OF UTMB HEALTHCARE SYSTEMS, INC. THIS CHANGE, WHILE NOT IMPACTING NET INCOME, DID RESULT IN A DRAMATIC INCREASE IN EXPENSES AND OFFSETTING REVENUE REPORTED. THESE ITEMS WERE PREVIOUSLY ONLY REPORTED ON THE BALANCE SHEET AS RECEIVABLES FROM THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON AND PAYABLES TO THE INDEPENDENT CONTRACTORS. UTMB HEALTHCARE SYSTEMS, INC. CONTINUES TO PROVIDE STAFFING TO THE UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON AS PART OF ITS MISSION TO IMPROVE THE HEALTH OF TEXAS COMMUNITIES BY CREATING A NETWORK OF HEALTHCARE PROFESSIONALS.
FORM 990 PART IX LINE 11G
DESCRIPTION:FILING FEES - DOCUMENTS TOTAL FEES:1525
FORM 990 PART IX LINE 11G
DESCRIPTION:GENERAL SERVICES TOTAL FEES:1184
FORM 990 PART IX LINE 11G
DESCRIPTION:FEES INCIDENTAL TOTAL FEES:69903
FORM 990 PART IX LINE 11G
DESCRIPTION:PERFUSIONISTS TOTAL FEES:61413
FORM 990 PART IX LINE 11G
DESCRIPTION:TEMPORARY EMPLOYMENT TOTAL FEES:7601998
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.