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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,052,775 | 2,250,207 | 2,355,216 | 1,856,941 | 1,309,382 | 9,824,521 |
| 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 | 2,052,775 | 2,250,207 | 2,355,216 | 1,856,941 | 1,309,382 | 9,824,521 |
| 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. | 9,824,521 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,052,775 | 2,250,207 | 2,355,216 | 1,856,941 | 1,309,382 | 9,824,521 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 2,285 | 3,350 | 6,998 | 2,652 | 2,440 | 17,725 |
| 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 | 10,089,695 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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, PAGE 2, PART III, LINE 4A | PARTNERSHIP FOR PATIENT CARE (PPC) IS A COLLABORATION BETWEEN INDEPENDENCE BLUE CROSS (IBC) AND THE PHILADELPHIA REGION'S HOSPITALS WITH THE VISION TO BE THE SAFEST REGION IN THE COUNTRY. AS A SIGNATURE PROGRAM OF HCIF, THIS UNIQUE COLLABORATION BETWEEN PAYER AND PROVIDERS TO SHARE SUCCESSFUL EXPERIENCES AND JOINTLY FUND QUALITY AND PATIENT SAFETY IMPROVEMENT INITIATIVES HAS BEEN RECOGNIZED AS A NATIONAL MODEL. OVER THE LAST DECADE- PLUS, PPC HAS FUNDED OVER 26 MULTI-YEAR COLLABORATIVES ADDRESSING A VARIETY OF QUALITY AND SAFETY PRIORITIES WITH THE REGION'S HOSPITALS. SAFE TABLE BRINGS THE REGION'S HOSPITAL QUALITY AND SAFETY LEADERS TOGETHER TO DISCUSS PATIENT SAFETY EVENTS, SOLUTIONS AND BEST PRACTICES IN A CONFIDENTIAL AND LEGALLY PROTECTED SETTING FOR THE PURPOSE OF PREVENTING RE-OCCURENCE AND IMPROVING PATIENT SAFTEY. SAFTEY FORUM WORKSHOPS HELP BUILD THE SKILLS OF THE FRONT LINE PATIENT SAFETY STAFF BY INTRODUCING DIFFERENT APPROACHES, BEST PRACTICES AND TOOLS FOR IDENTIFYING, MITIGATING, AND ELIMINATING PATIENT SAFETY VULNERABILITIES AND ERRORS. ANNUAL LEADERSHIP SUMMIT IS A MAJOR EVENT THAT BRINGS HEALTHCARE LEADERS TOGETHER FROM THE REGION'S HOSPITALS, HEALTHCARE SYSTEMS, AND OTHER PARTNER ORGANIZATIONS TO SHOWCASE PPC PROGRAMS, ADDRESS QUALITY AND SAFETY PRIORITIES, AND TO PROVIDE A FORUM FOR NETWORKING AND EXCHANGE OF BEST PRACTICES AND INNOVATION. PENNSYLVANIA UROLOGIC REGIONAL COLLABORATIVE (PURC) BRINGS UROLOGY TOGETHER IN A PHYSICIAN LED, DATA SHARING AND IMPROVEMENT COLLABORATIVE AIMED AT ADVANCING THE QUALITY OF DIAGNOSIS AND CARE FOR MEN WITH PROSTATE CANCER. HCIF SERVES AS THE COORDINATING CENTER, PROVIDING ADMINISTRATIVE, CLINICAL, AND DATABASE SUPPORT FOR PROGRAM MEMBERS. HEALTH EQUITY DATA STRATEGY (HEDS) FOCUSES ON SUPPORTING HOSPITALS IN REDUCING HEALTHCARE DISPARITIES THROUGH EFFECTIVE COLLECTION AND UTILIZATION OF RACIAL, ETHNICITY, AND LANGUAGE (REAL) DATA. PARTICIPANTS IN THIS MULTI-YEAR COLLABORATIVE LEARN BEST PRACTICES AND STRATEGIES FROM PEERS AND EXPERTS IN THE FIELD. DELAWARE VALLEY PATIENT SAFETY AND QUALITY AWARD PROMOTES BEST PRACTICES IN PATIENT SAFETY AND QUALITY IN THE SOUTHEAST PA REGION THROUGH RECOGNIZING HOSPITALS AND OTHER PROVIDERS FOR THEIR INNOVATIVE CONTRIBUTIONS IN ADVANCING PATIENT CARE AND DISSEMINATING THEIR AWARD-WINNING INITATIVES. |
| FORM 990, PART V | THE ORGANIZATION HAS AN EMPLOYEE LEASE AGREEMENT WITH THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ("HAP"). THE SALARIES AND BENEFITS REPORTED ON THIS FEDERAL FORM 990 REPRESENTS AMOUNTS PAID FOR EMPLOYEES PERFORMING SERVICES FOR THE ORGANIZATION UNDER THIS AGREEMENT. HAP REPORTS THE EMPLOYEES ON THEIR FORM W-3. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE BYLAWS ALLOW THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ("HAP") TO NOMINTE THREE PERSONS TO SERVE AS DIRECTORS AND SHALL HAVE THE FURTHER RIGHT TO NOMINATE REPLACEMENT DIRECTORS FOR ANY DEPARTING HAP DIRECTORS. THE BYLAWS ALLOW THE HOSPITAL AND HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA ("HAP") TO NOMINATE THREE BOARD MEMBERS OF THE HEALTH CARE IMPROVEMENT FOUNDAITON (HCIF). HAP HAS UTILIZED THIS BYLAW AND HAS PLACED NOMINEES ON THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FEDERAL FORM 990 IS PREPARED BY AN INDEPENDENT CPA FIRM AND IS PRESENTED TO THE FOUNDATION FOR REVIEW. THE PRESIDENT AND OTHER HCIF PROFESSIONALS REVIEW A DRAFT OF THE RETURN AND THEN PRESENT IT TO THE FINANCE COMMITTEE. AFTER THE FINANCE COMMITTEE REVIEWS A DRAFT OF THE 990, A COPY IS PROVIDED TO ALL BOARD MEMBERS FOR A REVIEW. AT THE NEXT SCHEDULED BOARD MEETING, THE FINANCE COMMITTEE WILL MOVE TO HAVE THE 990 ACCEPTED BY THE GOVERNING BODY. AFTER ACCEPTANCE, THE 990 IS FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL EMPLOYEES AND BOARD MEMBERS ARE REQUESTED TO DISCLOSE AND REVIEW ANNUALLY ANY POTENTIAL CONFLICTS OF INTEREST. THE BOARD ADOPTED AND IMPLEMENTED A CONFLICT OF INTEREST POLICY THAT REQUIRES ANNUAL ATTESTATION. BOARD MEMBERS ARE ASKED TO REFRAIN FROM VOTING AND RECUSE THEMSELVES FROM RELATED DISCUSSIONS WHEN A CONFLICT ARISES. EMPLOYEES ARE REQUIRED TO DISCLOSE ANY CONFLICTS AND REFRAIN FROM PARTICIPATION IN ANY ACTIONS WHICH COULD GIVE RISE TO CONFLICTS EXCEPT UPON APPROVAL OF THE BOARD AFTER FULL DISCLOSURE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE COMPENSATION REVIEW PROCESS INCLUDES A SELF-ASSESSMENT COMPONENT AND AN IN-PERSON INTERVIEW WITH THE EXECUTIVE COMMITTEE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE COMPENSATION REVIEW PROCESS INCLUDES A SELF-ASSESSMENT COMPONENT PERFORMED BY THE PRESIDENT OF THE ORGANIZATION CONTINUING WITH AN IN-PERSON INTERVIEW WITH THE EXECUTIVE COMMITTEE. THE FULL BOARD OF DIRECTORS DETERMINES COMPENSATION FOR KEY EMPLOYEES, AFTER RECOMMENDATIONS FROM THE EXECUTIVE COMMITTEE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
| FORM 990, PART IX, LINE 11G | CONSULTING & PROFESSIONAL 65,451 59,960 0 CONSULTING & PROFESSIONAL 216,755 0 0 HONORARIUMS 4,000 0 0 HONORARIUMS 9,657 0 0 SUB-CONTRACTED SERVICES 582 0 0 SUB-CONTRACTED SERVICES 33,322 0 0 MANAGEMENT & ADMIN 0 34,600 0 TOTAL 329,767 94,560 0 |
| Software ID: | |
| Software Version: |