Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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...... | 4,835,986 | 4,484,491 | 941,577 | 1,075,921 | 717,713 | 12,055,688 |
| 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. | 4,835,986 | 4,484,491 | 941,577 | 1,075,921 | 717,713 | 12,055,688 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 12,055,688 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 4,835,986 | 4,484,491 | 941,577 | 1,075,921 | 717,713 | 12,055,688 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 72,743 | 10,857 | 23,084 | 3,150 | 167 | 110,001 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 72,743 | 10,857 | 23,084 | 3,150 | 167 | 110,001 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 4,908,729 | 4,495,348 | 964,661 | 1,079,071 | 717,880 | 12,165,689 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | ALTHOUGH ANAHEIM MEMORIAL MEDICAL CENTER HAS 0 INDEPENDENT BOARD MEMBERS, THE ORGANIZATION IS CONTROLLED AND OVERSEEN BY A RELATED TAX-EXEMPT PARENT ORGANIZATION, MEMORIAL HEALTH SERVICES (MHS), WHICH DOES HAVE INDEPENDENT BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMORIAL HEALTH SERVICES IS THE SOLE CORPORATE MEMBER OF ANAHEIM MEMORIAL MEDICAL CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMORIAL HEALTH SERVICES (MHS) BOARD, AS THE RELATED TAX-EXEMPT PARENT ORGANIZATION AND CORPORATE MEMBER OF ANAHEIM MEMORIAL MEDICAL CENTER, APPOINTS THE MEMBERS OF ALL THE SUBSIDIARY BOARDS. THE MHS BOARD ALSO ELECTS ITS OWN MEMBERS TO SERVE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE EXERCISE OF THE FOLLOWING POWERS IS RESERVED TO THE CORPORATION'S MEMBER, MEMORIAL HEALTH SERVICES: A. ADOPT MISSION, PHILOSOPY AND VALUES STATEMENTS OF THE CORPORATION AND ANY AMENDMENTS OR SUPPLEMENTS TO SUCH STATEMENTS. B. AMEND ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. C. ELECT AND REMOVE DIRECTORS OF THE CORPORATION. D. SELL, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE CORPORATION. E. MERGE, CONSOLIDATE OR VOLUNTARILY DISSOLVE THE CORPORATION. F. FORM A SUBSIDIARY OR ENTER INTO AN AGREEMENT TO ACT AS A GENERAL PARTNER. G. RETAIN AN ATTORNEY OR FIRM OF ATTORNEYS TO PROVIDE LEGAL SERVICES FOR THE CORPORATION. H. AUTHORIZE THE PURCHASE OF INSURANCE PROVIDING COVERAGE FOR THE CORPORATION AND ITS PROPERTIES, AS WELL AS THE ESTABLISHMENT AND OPERATION OF A PROGRAM OF RISK MANAGEMENT. I. RETAIN AN ACCOUNTANT OR FIRM OF ACCOUNTANTS TO PROVIDE ACCOUNTING AND AUDITING SERVICES FOR THE CORPORATION. J. ADOPT ANNUAL OPERATING AND CAPITAL BUDGETS FOR THE CORPORATION. K. INCUR INDEBTEDNESS, AS SO DEFINED, IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES; L. AUTHORIZE ANY UNBUDGETED EXPENDITURE IN EXCESS OF $250,000 FOR CAPITAL IMPROVEMENTS TO THE PROPERTIES OWNED BY THE CORPORATION AND NOT APPROVED BY THE BUDGET PROCEDURE. M. ADOPT A STRATEGIC LONG-RANGE OR MASTER PLAN FOR THE CORPORATION AND TO RETAIN ANY CONSULTANTS WITH RESPECT THERETO. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER AND THE CHIEF INVESTMENT OFFICER/TREASURER REVIEWED THE 990 AND ALL RELATED SCHEDULES IN DETAIL AND THEN REVIEWED WITH THE ENTIRE BOARD PRIOR TO BEING FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12 | ANAHEIM MEMORIAL MEDICAL CENTER HAS THE FOLLOWING CONFLICT OF INTEREST POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2015. THE GENERAL COUNSEL'S OFFICE (OF MEMORIAL HEALTH SYSTEM) ANNUALLY SURVEYS EACH DIRECTOR AND OFFICER AND REQUIRES AFFIRMATION THAT THE CONFLICT OF INTEREST POLICY HAS BEEN READ AND UNDERSTOOD. THE RESULTS OF THE SURVEY ARE REPORTED TO THE GOVERNANCE COMMITTEE OF THE PARENT WHICH IS THE COMMITTEE RESPONSIBLE FOR GOVERNANCE OVERSIGHT AND NOMINATIONS. CONFLICTS ARE EVALUATED FOR BEING OCCASIONAL OR DISABLING IN NATURE. THE GENERAL COUNSEL MAKES THE INITIAL EVALUATION AND ADVISES THE GOVERNANCE COMMITTEE IN ITS DELIBERATIONS. IF AND AS AN OCCASIONAL CONFLICT IS IDENTIFIED, THE GENERAL COUNSEL ADVISES THE SUBJECT DIRECTOR AND GOVERNANCE IN A "REBUTTABLE PRESUMPTION" TYPE PROCESS. SHOULD A DISABLING CONFLICT BE IDENTIFIED, THE DIRECTOR RESIGNS OR IS REMOVED UPON THE RECOMMENDATION OF THE GENERAL COUNSEL, GOVERNANCE COMMITTEES AND BOARD. IN ADDITION, AN ANNUAL NOTICE IS SENT BY EMAIL TO EACH EMPLOYEE HAVING EMAIL REGARDING THE ACCEPTANCE OF GIFTS. FORM 990, PART VI, LINE 13 ANAHEIM MEMORIAL MEDICAL CENTER HAS A WHISTLEBLOWER POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2015. FORM 990, PART VI, LINE 14 ANAHEIM MEMORIAL MEDICAL CENTER HAS A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY BUT IT HAD NOT BEEN FORMALLY APPROVED BY THE BOARD OF DIRECTORS AS OF JUNE 30, 2015. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO OF THE ORGANIZATION IS NOT COMPENSATED BY THE FILING ORGANIZATION, BUT RATHER BY THE TAX-EXEMPT PARENT MEMORIAL HEALTH SERVICES (MHS). FOLLOWING IS THE PROCESS THAT THE PARENT ORGANIZATION UNDERTAKES TO APPROVE THE CEO'S COMPENSATION. WITHIN THE ORGANIZATION, THE COMPENSATION OF VICE PRESIDENT'S AND ABOVE IS REVIEWED BY AN EXTERNAL CONSULTANT WITH FINAL REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF THE MEMORIAL HEALTH SERVICES (MHS) BOARD OF DIRECTORS AND THEIR OUTSIDE COUNSEL. ALL MARKET DATA IS OBTAINED FROM THIRD PARTY SURVEY SOURCES. MARKET DATA REVIEWS ARE COMPLETED CONSISTENTLY ON AN ANNUAL BASIS IN ORDER TO DETERMINE APPROPRIATE COMPENSATION. FOR THE CURRENT REPORTING PERIOD, THE COMPENSATION DETERMINATION PROCESS WAS COMPLETED IN CALENDAR YEAR 2014. THE PROCESS OF DETERMINING THE COMPENSATION IS DOCUMENTED IN THE MINUTES OF THE MEMORIAL HEALTH SERVICES BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE CONFLICT OF INTEREST POLICY IS ON THE MHS WEBSITE. FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. GOVERNING DOCUMENTS ARE NOT AVAILABLE AT THIS TIME. |
| FORM 990, PART XI, LINE 9: | CHANGE IN POSTRETIREMENT LIABILITY -4,314,533. NET ASSETS TRANSFERRED FROM MEMORIAL HEALTH SERVICES 3,848,484. |
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