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
Eisenhower Medical Center
Employer identification number
95-6130458
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
Eisenhower Medical Center
Employer identification number
95-6130458
Return Reference
Explanation
FORM 990, PART III, LINE 4A
PROGRAM SERVICE ACCOMPLISHMENTS IN JULY 2013, EISENHOWER MEDICAL CENTER WAS NAMED FOR THE SECOND CONSECUTIVE YEAR AS ONE OF THE NATION'S MOST WIRED HOSPITALS IN THE 2013 MOST WIRED SURVEY BENCHMARKING STUDY RELEASED IN THE JULY ISSUE OF HOSPITALS & HEALTH NETWORKS, THE JOURNAL OF THE AMERICAN HOSPITAL ASSOCIATION. IN JULY 2013, EISENHOWER WAS RECOGNIZED AS A LEADER IN LGBT HEALTHCARE EQUALITY IN THE HEALTHCARE EQUALITY INDEX 2013, AN ANNUAL SURVEY CONDUCTED BY THE HUMAN RIGHTS CAMPAIGN (HRC) FOUNDATION. EISENHOWER EARNS TOP MARKS FOR ITS COMMITMENT TO EQUITABLE, INCLUSIVE CARE FOR LGBT PATIENTS AND THEIR FAMILIES. IN SEPTEMBER 2013, EISENHOWER LUCY CURCI CANCER CENTER HOSTED THE SIXTH ANNUAL ARNOLD PALMER PROSTATE CENTER SYMPOSIUM, A SERIES OF WEEKLY LECTURES REGARDING THE PREVENTION, DIAGNOSIS AND TREATMENT OF PROSTATE CANCER IN RECOGNITION OF NATIONAL PROSTATE CANCER AWARENESS MONTH. IN SEPTEMBER 2013, EISENHOWER WAS ONE OF 20 ORGANIZATIONS ACROSS THE NATION TO RECEIVE THE ADVISORY BOARD'S 2013 EXCELLENCE IN EMPLOYEE ENGAGEMENT AWARD. THE AWARD RECOGNIZES HOSPITALS AND HEALTH SYSTEMS THROUGHOUT THE UNITED STATES THAT EXHIBIT EXTRAORDINARY LEVELS OF WORKFORCE ENGAGEMENT BASED ON RESULTS FROM EMPLOYEE ENGAGEMENT SURVEYS. MORE THAN 300 U.S. HEALTH SYSTEMS WERE SURVEYED. IN OCTOBER 2013, EISENHOWER SCHNITZER/NOVACK BREAST CENTER HOSTED A SERIES OF LECTURES TO EDUCATE THE COMMUNITY ABOUT BREAST CANCER PREVENTION, SCREENING, DIAGNOSIS AND TREATMENT IN RECOGNITION OF NATIONAL BREAST CANCER AWARENESS MONTH. EISENHOWER WAS RECOGNIZED AS ONE OF THE TOP 97 HOSPITALS IN THE UNITED STATES FOR OUTCOMES FOLLOWING JOINT REPLACEMENT SURGERY ACCORDING TO A SURVEY BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. EISENHOWER IS ONE OF ONLY EIGHT CALIFORNIA HOSPITALS ON THE LIST. IN FEBRUARY 2014, EISENHOWER DESERT CARDIOLOGY CENTER WAS THE FIRST IN RIVERSIDE COUNTY (AND SIXTH NATIONWIDE) TO UTILIZE THE DIAMONDBACK 360(R) CORONARY ORBITAL ATHERECTOMY SYSTEM AFTER ITS RECENT FOOD AND DRUG ADMINISTRATION (FDA) APPROVAL. THE TOOL IS USED FOR TREATMENT OF SEVERELY CALCIFIED CORONARY ARTERIES. ON FEBRUARY 1, 2014, EISENHOWER MEDICAL CENTER HOSTED THE 11TH ANNUAL COMMUNITY HEART CONFERENCE AT THE ANNENBERG CENTER FOR HEALTH SCIENCES. IN FEBRUARY 2014, EISENHOWER MEDICAL CENTER VOLUNTEERS REACHED A MILESTONE OF FIVE MILLION HOURS OF COMMUNITY SERVICE, GIVEN OVER THE PAST FOUR DECADES. IN FEBRUARY, EISENHOWER MEDICAL CENTER'S STROKE PROGRAM EARNED RECERTIFICATION AS AN ADVANCED PRIMARY STROKE CENTER BY THE JOINT COMMISSION. EISENHOWER WAS THE FIRST FACILITY IN THE RIVERSIDE AND SAN BERNARDINO COUNTIES TO BECOME AN ADVANCED PRIMARY STROKE CENTER IN 2009. ON MARCH 8, 2014, EISENHOWER LUCY CURCI CANCER CENTER HOSTED THE 11TH ANNUAL COMMUNITY CANCER AWARENESS DAY WITH A FOCUS ON COLON CANCER. ON MARCH 22, 2014, EISENHOWER HOSTED THE 19TH ANNUAL JIM COOK DAY OF HOPE FOR DIABETES, FEATURING AWARD-WINNING ACTOR/SINGER TONY ORLANDO, AT THE ANNENBERG CENTER FOR HEALTH SCIENCES AT EISENHOWER. IN MARCH 2014, EISENHOWER MEDICAL CENTER'S RESIDENCY PROGRAM FILLED ALL OF ITS AVAILABLE SLOTS IN THE PROGRAM'S SECOND YEAR. EISENHOWER IS THE FIRST HOSPITAL IN THE VALLEY TO OFFER AN ACCREDITED RESIDENCY PROGRAM. IN APRIL 2014, EISENHOWER WAS HONORED WITH AN "A" RATING - THE TOP GRADE IN PATIENT SAFETY - IN THE HOSPITAL SAFETY SCORE ADMINISTERED BY THE LEAPFROG GROUP. THE FIRST AND ONLY HOSPITAL SAFETY RATING TO BE PEER-REVIEWED IN THE JOURNAL OF PATIENT SAFETY, THE SCORE IS FREE TO THE PUBLIC AND DESIGNED TO GIVE CONSUMERS INFORMATION THEY CAN USE TO PROTECT THEMSELVES AND THEIR FAMILIES WHEN FACING A HOSPITAL STAY. IN SPRING 2014, BIGHORN BEHIND A MIRACLE (BAM) DONATED ONE MILLION DOLLARS TO EISENHOWER LUCY CURCI CANCER CENTER, THEIR LARGEST DONATION PROVIDING CRITICAL FUNDING TO HELP IN THE DIAGNOSIS, TREATMENT, RESEARCH, SERVICES AND EDUCATION FOR THOSE AFFECTED BY BREAST CANCER.
FORM 990, PART VI, LINE 2
FAMILY OR BUSINESS RELATIONSHIPS KATHRYN B. SAMPLE AND STEVEN B. SAMPLE, BOTH ON THE BOARD OF TRUSTEES, ARE MARRIED.
FORM 990, PART VI, LINE 6
MEMBERS OR STOCKHOLDERS THE BOARD OF TRUSTEES ARE MEMBERS OF EISENHOWER MEDICAL CENTER.
FORM 990, PART VI, LINE 7A
POWER TO ELECT OR APPOINT MEMBERS TRUSTEES HAVE THE RIGHT TO ELECT THE GOVERNING BOARD MEMBERS OF THE EISENHOWER MEDICAL CENTER BOARD OF DIRECTORS.
FORM 990, PART VI, LINE 7B
DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS MEMBERS HAVE THE RIGHT TO VOTE ON THE FOLLOWING MAJOR DECISIONS: ANY MATERIAL CHANGE IN THE MISSION OF EMC; THE MERGER OF EMC WITH ANY OTHER BUSINESS ENTITY; THE DISSOLUTION OF EMC; THE SALE OF ALL OR SUBSTANTIALLY ALL OF EMC'S ASSETS; AND ANY MATTER ON WHICH A MEMBER OF A CALIFORNIA NON-PROFIT CORPORATION IS REQUIRED TO BE PERMITTED TO VOTE ON UNDER APPLICABLE LAW.
FORM 990, PART VI, LINE 11B
PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND SUBSEQUENTLY REVIEWED BY MANAGEMENT. AFTER MANAGEMENT REVIEW, THE FORM 990 IS PRESENTED TO THE BOARD AFTER FILING.
FORM 990, PART VI, LINE 12C
MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST ANNUALLY, RELATED PARTIES INCLUDING OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES ARE SURVEYED FOR TRANSACTIONS THAT COULD GIVE RISE TO CONFLICTS. WRITTEN QUESTIONNAIRES ARE REVIEWED BY LEGAL AND FINANCE TO DETERMINE IF ADDITIONAL QUESTIONS OR INFORMATION SHOULD BE DOCUMENTED REGARDING SPECIFIC TRANSACTIONS. ALL NEW CONTRACTS ARE REVIEWED BY EXECUTIVE MANAGEMENT FOR CONFLICT CONSIDERATIONS. GENERAL COUNSEL REVIEWS ALL STATEMENTS SUBMITTED BY BOARD MEMBERS WHO INDICATE A POTENTIAL CONFLICT. GENERAL COUNSEL ADVISES THE CEO AND CHAIRMAN OF THE BOARD OF ANY MATERIAL CONFLICTS SO THAT THE INDIVIDUAL CAN BE RECUSED FROM ANY DISCUSSION OR DELIBERATION PERTAINING TO THE CONFLICT.
FORM 990, PART VI, LINE 15A & 15B
PROCESS FOR DETERMINING COMPENSATION EISENHOWER MEDICAL CENTER ENGAGES AN INDEPENDENT CONSULTING FIRM TO PROVIDE THE BOARD'S COMPENSATION COMMITTEE BENCHMARKED SURVEY DATA FOR THE EXECUTIVE LEADERSHIP TEAM IN THE ORGANIZATION. THE CONSULTANT PROVIDES ANALYSIS OF SALARIES, INCENTIVE PLANS AND BENEFITS AS COMPARED TO PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS. THIS REVIEW WAS COMPLETED AND PRESENTED TO THE COMPENSATION COMMITTEE IN JANUARY 2014. THIS PROCESS WAS CONTEMPORANEOUSLY SUBSTANTIATED IN THE MEETING MINUTES OF THE COMPENSATION COMMITTEE.
FORM 990, PART VI, LINE 19
PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC EISENHOWER MEDICAL CENTER RELEASES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC UPON REQUEST. THAT REQUEST MAY BE EITHER VERBAL OR WRITTEN.
FORM 990, PART IX, LINE 11G
OTHER FEES FOR SERVICES REPRESENTS PURCHASED SERVICES: PHYSICIAN SERVICES $41,117,605 PURCHASED SERVICES - OTHER $17,440,342 OTHER MEDICAL SERVICES - $ 4,455,687 COLLECTION SERVICES - $ 3,627,895 MISC. PURCHASED SERVICES $19,371,192 ----------- TOTAL $86,012,721
FORM 990, PART XI, LINE 9
OTHER CHANGES IN NET ASSETS PENSION RELATED CHANGES: $ 2,536,147 CHANGE IN VALUE OF CHARITABLE REMAINDER TRUSTS: $(2,012,774) CHANGE IN NPV OF PLEDGES: $ 1,526,433 ------------ TOTAL $ 2,049,806
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.