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 | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,277,073 | 3,203,739 | 2,347,498 | 3,348,505 | 2,287,844 | 13,464,659 |
| 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 | 2,277,073 | 3,203,739 | 2,347,498 | 3,348,505 | 2,287,844 | 13,464,659 |
| 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).. | 880,702 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 12,583,957 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,277,073 | 3,203,739 | 2,347,498 | 3,348,505 | 2,287,844 | 13,464,659 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 655,153 | 786,550 | 947,424 | 712,381 | 617,510 | 3,719,018 |
| 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.).. | 271,577 | 133,961 | 183,448 | 84,536 | 55,048 | 728,570 |
| 11 | Total support. Add lines 7 through 10 | 17,912,247 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES WAS PROVIDED TO THE GOVERNING BOARD BEFORE FILING IN ELECTRONIC FORM. AN EMAIL WAS SENT TO ALL MEMBERS OF THE GOVERNING BODY CONTAINING A LINK TO A PASSWORD-PROTECTED WEBSITE ON WHICH THE ENTIRE 990 COULD BE VIEWED. THE EMAIL EXPLAINED THAT THE FORM 990 WAS AVAILABLE FOR REVIEW ON THE WEBSITE. |
| FORM 990, PART VI, SECTION B, LINE 12C | EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS THE CONFLICT OF INTEREST POLICY IS AS FOLLOWS: I. POLICY 1. EACH CORPORATE BOARD OF THE UNIVERSITY HEALTH CARE SYSTEM HAS ADOPTED A CONFLICT OF INTEREST POLICY BINDING UPON THE BOARD'S MEMBER AND THE CORPORATION CHIEF EXECUTIVE OFFICER. AS A RESULT OF THE DIVERSE INTERESTS AND BACKGROUNDS OF ADMINISTRATIVE, SUPERVISORY, AND STAFF EMPLOYEES, AT TIMES THERE MAY ARISE INSTANCES WHEN AN INDIVIDUAL'S PERSONAL OR OUTSIDE INTERESTS CONFLICT WITH THOSE OF THE SYSTEM OR A CONSTITUENT ORGANIZATION (FOR EXAMPLE, BUT NOT LIMITED TO UNIVERSITY HEALTH SERVICES D/B/A UNIVERSITY HOSPITAL, UNIVERSITY EXTENDED CARE D/B/A KENTWOOD AND WESTWOOD, UNIVERSITY HEALTH, AND UNIVERSITY HEALTH RESOURCES). POSSIBLE CONFLICTS OF INTEREST CAN OCCUR IN THE FOLLOWING INSTANCES: A. FINANCIAL INVESTMENTS AND OWNERSHIP WHEN AN EMPLOYEE OR HIS/HER IMMEDIATE FAMILY HAS A MATERIAL FINANCIAL INVESTMENT OR OWNERSHIP INTEREST IN ANY ORGANIZATION OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOOD OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES. AN INVESTMENT OR OWNERSHIP INTEREST WITH A VALUE OF $2,500.00 OR MORE IS PRESUMED MATERIAL; A SMALLER INTEREST MAY BE MATERIAL DEPENDING ON THE CIRCUMSTANCES. OWNERSHIP OF PUBLICLY TRADED STOCK IS NOT CONSIDERED A MATERIAL INTEREST UNLESS THE OWNER EXERCISES DISCRETIONARY AUTHORITY WITH RESPECT TO THE SYSTEM'S BUSINESS DEALING WITH THE COMPANY IN WHICH THE PERSON OWNS STOCK WORTH $5,000.00 OR MORE. NORMALLY, ONLY AN INDIVIDUAL AT OR ABOVE THE DEPARTMENT HEAD LEVEL WOULD BE IN A POSITION TO EXERCISE THE REQUISITE DISCRETIONARY AUTHORITY. B. CONSULTING AND MANAGEMENT SERVICES WHEN AN EMPLOYEE OR HIS/HER IMMEDIATE FAMILY PROVIDES MANAGERIAL, CONSULTATIVE, OR ADVISORY SERVICES TO ANY PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPLETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES OTHER THAN THE INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER PERSONAL MEDICAL CARE SERVICES. C. GIFTS WHEN A SYSTEM EMPLOYEE OR HIS/HER IMMEDIATE FAMILY ACCEPTS GIFTS, GRATUITIES, ENTERTAINMENT, OR FAVORS INCLUDING SEMINARS, FACTORY VISITS, OR SITE VISITS FROM A PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS OR SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES OTHER THAN INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER PERSONAL MEDICAL CARE SERVICES. THIS DOES NOT INCLUDE THE ACCEPTANCE OF ITEMS OF NOMINAL VALUE, WHICH COULD NOT BE CONSTRUED AS INTENDED TO INFLUENCE THE INDIVIDUAL IN THE PERFORMANCE OF HIS OR HER DUTIES. DISCLOSURE IS REQUIRED WITH RESPECT TO ANY SINGLE GIFT, GRATUITY, ENTERTAINMENT, OR FAVOR WHICH HAS A FAIR MARKET VALUE IN EXCESS OF $150.00 AND WITH RESPECT TO ALL SUCH ITEMS RECEIVED DURING ANY CALENDAR YEAR FROM A SINGLE SOURCE IF THE CUMULATIVE MARKET VALUE OF THOSE ITEMS EXCEEDS $250.00. DISCLOSURE IS NOT REQUIRED WITH RESPECT TO PARTICIPATION IN HOSPITAL-SPONSORED EVENTS, FOR EXAMPLE, WHEN SOMEONE, PAY'S AN EMPLOYEE'S PARTICIPATION FEE IN A HOSPITAL-SPONSORED EVENT LIKE THE JERNIGAN CANCER GOLF TOURNAMENT. ALL VENDOR FUNDED TRAVEL (INCLUDING SITE VISITS, FACTORY VISITS, AND SEMINARS) IS PROHIBITED. THIS PROHIBITION IS NOT APPLICABLE TO VENDOR FUNDED TRAVEL APPROVED BY THE CEO USING THE POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORM, PURSUANT TO A HOSPITAL CONTRACT, OR FUNDED BY A GROUP PURCHASING ORGANIZATION IN WHICH THE HOSPITAL IS A MEMBER. D. EMPLOYMENT AND GIFTS WHEN AN EMPLOYEE HAS ANY OUTSIDE EMPLOYMENT THAT MIGHT INTERFERE WITH PERFORMANCE OF HIS OR HER UNIVERSITY JOB, EACH MANAGEMENT LEVEL EMPLOYEE MUST DISCLOSE ANY OUTSIDE EMPLOYMENT, INCLUDING SELF-EMPLOYMENT, WHICH HAS GENERATED OR IS REASONABLY EXPECTED TO GENERATE MORE THAN $10,000 IN GROSS INCOME DURING THE CALENDAR YEAR. INVESTMENT INCOME IS NOT CONSIDERED TO BE DERIVED FROM EMPLOYMENT. E. NON-PUBLIC INFORMATION WHEN AN EMPLOYEE IS IN A RELATIONSHIP (EITHER PERSONAL OR BUSINESS) IN WHICH HE/SHE WOULD GAIN PERSONAL ADVANTAGE BY DISCLOSURE OF NON-PUBLIC SYSTEM INFORMATION TO A PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES OR COULD PROVIDE GOODS OR SERVICES OTHER THAN INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER MEDICAL CARE SERVICES. F. HIRING PROCESS WHEN AN EMPLOYEE PARTICIPATING IN A HIRING PROCESS COULD GAIN A PERSONAL BENEFIT FROM THE HIRING DECISION. 2. ALL SYSTEM EMPLOYEES HAVE AN OBLIGATION TO DISCLOSE RELEVANT INFORMATION ABOUT POTENTIAL CONFLICTS OF INTEREST. ALL SYSTEM EMPLOYEES HAVE AN OBLIGATION TO AVOID ACTUAL CONFLICTS OF INTEREST. AVOIDING CONFLICTS OF INTEREST INCLUDES AVOIDING OR DISENGAGING FROM ACTIVITIES AND RELATIONSHIPS WHOSE APPEARANCE UNDERMINES CONFIDENCE IN THE INTEGRITY OF THE SYSTEM. 3. EMPLOYEES WHO FAIL TO DISCLOSE OR CONTINUE TO ENGAGE IN ACTIVITIES THAT HAVE BEEN DEEMED TO BE A CONFLICT OF INTEREST WILL BE SUBJECT TO DISCIPLINARY ACTION. 4. DEFINITIONS A. IMMEDIATE FAMILY MEANS ONE'S SPOUSE, ONE'S DESCENDANTS (CHILDREN, GRANDCHILDREN, ETC.) ONE'S SIBLINGS, THE SPOUSE OF ANY OF THE FORGOING, AND ONE'S PARENTS-IN-LAW. THIS POLICY DOES NOT OBLIGATE A SYSTEM EMPLOYEE TO MAKE ANY INQUIRIES CONCERNING THE ACTIVITIES OF AND OWNERSHIP INTERESTS OF HIS/HER IMMEDIATE FAMILY, BUT THE POLICY DOES REQUIRE A SYSTEM EMPLOYEE WHO IS AWARE OF OR SHOULD BE AWARE OF A POTENTIAL CONFLICT OF INTEREST THROUGH A FAMILY MEMBER TO REPORT THAT POTENTIAL CONFLICT. B. FAIR MARKET VALUE MEANS THE AMOUNT AT WHICH PARTICULAR GOODS OR SERVICES ARE SOLD TO THE GENERAL PUBLIC. C. SYSTEM MEAN THE UNIVERSITY HOSPITAL AND ALSO ANY OTHER ORGANIZATIONAL ELEMENT OF THE UNIVERSITY HEALTH, INC. FAMILY (E.G., UNIVERSITY EXTENDED CARE, INC.) OVER WHICH AN EMPLOYEE EXERCISES DISCRETIONARY AUTHORITY WITH RESPECT TO PURCHASES OR SALES OF GOODS OR SERVICES. D. SOURCE MEANS A PERSON, INSTITUTION OR ORGANIZATION FROM WHICH THE SYSTEM PURCHASES OR IS CONSIDERING PURCHASING GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES. SEPARATE BUSINESS ORGANIZATIONS AND OWNERS WHICH ARE PART OF THE SAME CORPORATE FAMILY ARE ONE SOURCE. THE VALUE OF ALL ENTERTAINMENT, GIFTS, ETC. RECEIVED FROM THE DIFFERENT MEMBERS OF ONE CORPORATE FAMILY MUST BE AGGREGATED FOR PURPOSES OF COMPLIANCE WITH THIS POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES THE ORGANIZATION FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 53.4958-6(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES BOARD, COMPRISED OF THREE INDEPENDENT BOARD MEMBERS, REVIEWS THE COMPENSATION OF THE CEO AND OTHER SENIOR MANAGEMENT MEMBERS. THE REVIEW IS CONDUCTED IN THE CONTEXT OF A BOARD APPROVED EXECUTIVE COMPENSATION PHILOSOPHY. BOTH THE DEVELOPMENT OF THE COMPENSATION PHILOSOPHY AND THE REVIEW INVOLVE THE ADVICE AND ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM. MINUTES OF THE COMPENSATION COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UNIVERSITY HEALTH SERVICES BOARD EXECUTIVE COMMITTEE. ALL OF THE STAFF OF UNIVERSITY HEALTH CARE FOUNDATION ARE EMPLOYED AND THEREFORE PAID BY UNIVERSITY HEALTH SERVICES, INC. SINCE ALL STAFF MEMBERS ARE EMPLOYED BY UNIVERSITY HEALTH SERVICES, INC., UNIVERSITY HEALTH CARE FOUNDATION COMPLIES WITH THE ABOVE MENTIONED PROCEDURE. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS, AND INFORMATIONAL RETURNS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO AVAILBALE ON WWW.GUIDESTAR.ORG. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER FROM UHS 710,751. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |