Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 | |||||
| (A)
UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE |
916001537 | 2 | Yes | 21,521,882 | 0 | |
| (B)
SEATTLE CHILDREN'S HOSPITAL |
910564748 | 3 | Yes | 22,695,946 | 0 | |
|
Total 2
|
44,217,828 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 6: | THERE WERE 16 UNPAID FACULTY MEMBERS WHO VOLUNTEERED TO PROVIDE CLINICAL CARE THROUGH CUMG. |
| FORM 990, PART VI, SECTION A, LINE 6 | THERE ARE TWO MEMBERS OF CHILDREN'S UNIVERSITY MEDICAL GROUP: SEATTLE CHILDREN'S HEALTHCARE SYSTEM (THE SURVIVING ENTITY OF CHILDREN'S PHYSICIANS) AND THE UNIVERSITY OF WASHINGTON. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE UW MEDICINE CEO AND CEO OF SEATTLE CHILDREN'S HOSPITAL TOGETHER APPOINT TEN MEMBERS OF THE BOARD OF DIRECTORS. PROFESSIONAL FACULTY MEMBERS ELECT TWO MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | MOST DECISIONS OF THE CUMG BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THE UW MEDICINE CEO AND CEO OF SEATTLE CHILDREN'S HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE COMPLETED FORM 990 IS REVIEWED BY THE CUMG SENIOR DIRECTOR OF FINANCE, GENERAL COUNSEL FOR THE ASSOCIATION OF UNIVERSITY PHYSICIANS AND CUMG, AND THE CUMG CONTROLLER, AS WELL AS THE ASSOCIATE DEAN FOR ADMINISTRATION AND FINANCE FOR THE UW SCHOOL OF MEDICINE, THE UW MEDICINE CHIEF FINANCIAL OFFICER, AND THE VICE PRESIDENT OF FINANCE AND CONTROLLER FOR SEATTLE CHILDREN'S HOSPITAL. THE BOARD HAS BEEN PRESENTED WITH INFORMATION RELATED TO THE PURPOSE AND RELEVANCE OF THE FORM 990 TO TAX-EXEMPT ENTITIES, SUCH AS CUMG, AND BOARD MEMBERS MAY REQUEST A COPY OF THE FORM 990 FROM THE CUMG CONTROLLER. |
| FORM 990, PART VI, SECTION B, LINE 12C | CUMG MAINTAINS A CONFLICT OF INTEREST POLICY APPLICABLE TO BOARD AND COMMITTEE MEMBERS. IN ADDITION, CUMG BOARD MEMBERS AND OTHER INDIVIDUALS WHO ARE EMPLOYED BY THE UNIVERSITY OF WASHINGTON AND SERVING ON CUMG COMMITTEES ARE SUBJECT TO THE STATE OF WASHINGTON ETHICS IN PUBLIC SERVICE ACT, CHAPTER 42.52 RCW. THE ACT RESTRICTS ACTIVITIES INCOMPATIBLE WITH THE INDIVIDUAL'S ROLE AS A STATE EMPLOYEE AND ALSO LIMITS THE INDIVIDUAL'S INVOLVEMENT IN TRANSACTIONS WHERE A POTENTIAL CONFLICT MAY EXIST. CUMG BOARD MEMBERS AND OTHERS ARE REQUIRED TO DISCLOSE CERTAIN RELATIONSHIPS BOTH TO COMPLETE THE CUMG CONFLICT OF INTEREST SURVEY AND AS PART OF THE PROCESS TO COMPLETE THE FORM 990. CUMG ALSO ADDRESSES CONFLICTS AS THEY ARISE AND ARE REPORTED TO CUMG MANAGEMENT OR THE CUMG BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CUMG BOARD OF DIRECTORS DO NOT REVIEW COMPENSATION. COMPENSATION OF THE CUMG EXECUTIVE DIRECTOR IS REVIEWED BY REPRESENTATIVES OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. THE REVIEW RELIES ON COMPARISON OF COMPENSATION TO SIMILARLY SITUATED INDIVIDUALS, IN LIKE-SIZED ORGANIZATIONS ENGAGED IN SIMILAR ACTIVITIES. THE COMPARISON IS PERFORMED BY AN INDEPENDENT CONTRACTOR CONSULTANT WITH EXPERIENCE AND EXPERTISE IN COMPENSATION OF ACADEMIC MEDICAL CENTER PERSONNEL. THE COMPENSATION COMPARISON DATA IS REVIEWED BY DISINTERESTED EMPLOYEES OF UW MEDICINE AND SEATTLE CHILDREN'S HOSPITAL. FOR UW MEDICINE, THIS IS PART OF AN OVERALL REVIEW OF COMPENSATION FOR SIMILARLY SITUATED INDIVIDUALS IN OTHER COMPONENTS OF UW MEDICINE. THE REVIEW IS PERFORMED REGULARLY, AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. COMPENSATION OF CUMG BOARD MEMBERS AND OFFICERS IN THEIR CAPACITY AS CUMG PROFESSIONAL MEMBERS EMPLOYED BY CUMG AND/OR THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE, IS REVIEWED REGULARLY THROUGH A UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE PROCESS THAT INVOLVES DISINTERESTED SCHOOL OF MEDICINE EMPLOYEES WHO REVIEW COMPENSATION OF ALL SCHOOL OF MEDICINE FACULTY. FOR CUMG PROFESSIONAL MEMBERS, REVIEW OF COMPENSATION ALSO INCLUDES APPLICATION OF THE "CHILDREN'S UNIVERSITY MEDICAL GROUP METHOD OR STANDARD REGARDING BASIC INDIVIDUAL CAPS UNDER AMENDED INCOME DISTRIBUTION PLAN, AS OF JULY 1, 1999" (CUMG CAP POLICY). THE CUMG CAP POLICY LIMITS COMPENSATION OF CUMG PROFESSIONAL MEMBERS BY COMPARISON TO OBJECTIVE DATA SUCH AS THAT PUBLISHED BY THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES. THE REVIEW IS PERFORMED REGULARLY AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, LINE 13: | CUMG HAS A POLICY THAT REQUIRES MEMBERS AND ADMINISTRATIVE STAFF TO REPORT BILLING COMPLIANCE CONCERNS. THE POLICY EMPHASIZES THAT CUMG DOES NOT TOLERATE RETALIATION AGAINST THOSE REPORTING CONCERNS. THIS POLICY IS AVAILABLE TO ALL CUMG MEMBERS AND ADMINISTRATIVE STAFF AND IS BROADLY DISSEMINATED. |
| FORM 990, PART VI, LINE 3: | IN FISCAL YEAR 2020, CUMG PAID SEATTLE CHILDREN'S HOSPITAL FOR THE SERVICES OF THE CUMG EXECUTIVE DIRECTOR, CHRISTINE KESSLER. CHRISTINE TRANSITIONED TO SEATTLE CHILDREN'S EMPLOYMENT IN FISCAL YEAR 2018, AS DID CUMG ADMINISTRATIVE STAFF. CUMG PRACTICE MANAGEMENT AND ADMINISTRATION ARE INCLUDED IN OTHER FEES FOR NON-EMPLOYEE SERVICES IN PART IX FUNCTIONAL EXPENSES. |
| FORM 990, PART VII, COLUMN B: | HOURS FOR RELATED ORGANIZATIONS: ALL OF THE BOARD MEMBERS AND HIGHEST COMPENSATED EMPLOYEES, EXCEPT FOR THE CONTROLLER AND THE EXECUTIVE DIRECTOR, ARE CONSIDERED BY THE UNIVERSITY OF WASHINGTON TO BE EMPLOYED FULL TIME BY THE UNIVERSITY OF WASHINGTON REGARDLESS OF WHETHER THEY RECEIVE ALL OF THEIR COMPENSATION FROM ANY COMBINATION OF THE UNIVERSITY, CUMG, OR SEATTLE CHILDREN'S HOSPITAL. BOARD MEMBERS ARE MEMBERS OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE FACULTY, AND THEY PROVIDE CLINICAL SERVICES IN THEIR ROLE AS FACULTY MEMBERS IN SERVICE TO THE UNIVERSITY. LIKEWISE, A BOARD MEMBER'S SERVICE AS A MEMBER OF THE BOARD IS INCLUDED AS PART OF HIS OR HER ROLE AS A FACULTY MEMBER IN SERVICE TO THE UNIVERSITY AND, FOR THOSE HIGHEST COMPENSATED EMPLOYEES WHO ARE NOT BOARD MEMBERS, ALL OF THEIR ACTIVITIES FOR CUMG ARE CONSIDERED TO BE WITHIN THE INDIVIDUAL'S FACULTY ROLE FOR THE UNIVERSITY OR SEATTLE CHILDREN'S HOSPITAL. WE ARE NOT ABLE TO SEGREGATE THE HOURS DEVOTED TO CUMG FROM THE HOURS EACH INDIVIDUAL DEVOTES TO THE UNIVERSITY OR SEATTLE CHILDREN'S HOSPITAL. THUS, WE ARE REPORTING 40 HOURS FOR EACH INDIVIDUAL, TO REPRESENT THAT INDIVIDUAL'S TOTAL WORK EFFORT INCLUDING FOR THE RELATED PARTY UNIVERSITY OF WASHINGTON AND SEATTLE CHILDREN'S HOSPITAL. |
| Software ID: | |
| Software Version: |