TY 2012 Form 990 Schedule O

efile Public Visual Render ObjectId: 201421149349300727 - Submission: 2014-04-24 TIN: 56-2420913

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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION

Employer identification number

56-2420913

Identifier	Return Reference	Explanation
	FORM 990, PART V LINE 2:	THE FOUNDATION DOES NOT HAVE ANY EMPLOYEES TO REPORT ON PART V LINE 2. EMPLOYEES WORKING FOR THE FOUNDATION ARE EMPLOYEES OF JEFFERSON REGIONAL MEDICAL CENTER. SALARIES ON PART IX REPRESENT THE FOUNDATION'S ALLOCATED PORTION OF PAYROLL EXPENSE. JRMC FOUNDATION ISSUES NO W-2 FORMS, THE W-2 FORMS ARE ISSUED BY JEFFERSON REGIONAL MEDICAL CENTER (EIN 25-1260215), THE PARENT ORGANIZATION.
	FORM 990, PART VI, SECTION A, LINE 2	DIRECTORS AARON BILGER, GREGORY DEVINE, EVAN FRAZIER, AND DANIEL ONORATO HAVE A BUSINESS RELATIONSHIP.
	FORM 990, PART VI, SECTION A, LINE 4	IN ANTICIPATION OF ENTERING INTO THE AFFILIATION AGREEMENT PREVIOUSLY DISCUSSED AT PART III, LINE 4(A), THE JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION AMENDED ITS ARTICLES OF INCORPORATION AND BYLAWS. SIGNIFICANT AMONG THE CHANGES IMPLEMENTED BY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS WERE THE REMOVAL OF JEFFERSON REGIONAL MEDICAL CENTER AS THE SOLE "MEMBER" OF THE FOUNDATION, AS THAT TERM IS DEFINED UNDER PENNSYLVANIA LAW. IN ADDITION, THE BYLAWS OUTLINE THE FUTURE APPOINTMENT PROCESS FOR MEMBERS OF THE FOUNDATION'S BOARD OF DIRECTORS.
	FORM 990, PART VI, SECTION B, LINE 11	THE FINAL VERSION OF THE 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW. INFORMATION AND ITEMS CAN BE CLARIFIED AND CONFIRMED WITH EXECUTIVE MANAGEMENT AND OTHER MEMBERS OF THE BOARD. CORRECTIONS AND CLARIFICATIONS ARE SUBMITTED OR SUGGESTED PRIOR TO THE FILING OF THE RETURN.
	FORM 990, PART VI, SECTION B, LINE 12C	PERIODIC REVIEWS ARE CONDUCTED AND MAY INCLUDE ASSISTANCE FROM OUTSIDE ADVISORS TO ENSURE JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION IS OPERATING IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSE AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX EXEMPT STATUS. A DISCLOSURE PROCEDURE OUTLINED IN THE CONFLICT OF INTEREST POLICY INCLUDES SUBMISSION OF THE ANNUAL DISCLOSURE STATEMENT AS WELL AS LETTERS, MEMOS, OR OTHER DISCLOSURES TO THE BOARD. THIS PROCEDURE IS MONITORED BY OTHER MEMBERS OF THE BOARD AS WELL AS LEGAL COUNSEL. THE SCOPE OF COVERAGE FOR THE CONFLICT OF INTEREST POLICY IS DIRECTED TOWARDS "POTENTIALLY INTERESTED PARTIES" INCLUDING, BUT NOT LIMITED TO: DIRECTORS, OFFICERS, KEY EMPLOYEES, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS, PERSONS WHO HAVE AUTHORITY TO ENTER INTO CONTRACTS OR AGREEMENTS, PERSONS WITH ACCESS TO RESTRICTED, SENSITIVE OR CONFIDENTIAL INFORMATION WHICH COULD BE VALUABLE TO NON-JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION ENTITIES, AND PERSONS WITH A SIGNIFICANT FINANCIAL INTEREST OR INFLUENTIAL INTEREST. JEFFERSON REGIONAL MEDICAL CENTER PRESIDENT & CHIEF OPERATING OFFICER, BY AUTHORITY OF THE BOARD, IS THE DESIGNATED ADMINISTRATOR FOR INTERPRETATION AND IMPLEMENTATION OF THIS POLICY AND ALL PROCEDURES RELATING TO IT. FAILURE TO COMPLY WITH THIS POLICY MAY INCLUDE A DETERMINATION FOR THE POTENTIALLY INTERESTED PARTY TO SEVER ALL TIES WITH JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION.
	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Identifier

Return Reference

Explanation

FORM 990, PART V LINE 2:

THE FOUNDATION DOES NOT HAVE ANY EMPLOYEES TO REPORT ON PART V LINE 2. EMPLOYEES WORKING FOR THE FOUNDATION ARE EMPLOYEES OF JEFFERSON REGIONAL MEDICAL CENTER. SALARIES ON PART IX REPRESENT THE FOUNDATION'S ALLOCATED PORTION OF PAYROLL EXPENSE. JRMC FOUNDATION ISSUES NO W-2 FORMS, THE W-2 FORMS ARE ISSUED BY JEFFERSON REGIONAL MEDICAL CENTER (EIN 25-1260215), THE PARENT ORGANIZATION.

FORM 990, PART VI, SECTION A, LINE 2

DIRECTORS AARON BILGER, GREGORY DEVINE, EVAN FRAZIER, AND DANIEL ONORATO HAVE A BUSINESS RELATIONSHIP.

FORM 990, PART VI, SECTION A, LINE 4

IN ANTICIPATION OF ENTERING INTO THE AFFILIATION AGREEMENT PREVIOUSLY DISCUSSED AT PART III, LINE 4(A), THE JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION AMENDED ITS ARTICLES OF INCORPORATION AND BYLAWS. SIGNIFICANT AMONG THE CHANGES IMPLEMENTED BY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS WERE THE REMOVAL OF JEFFERSON REGIONAL MEDICAL CENTER AS THE SOLE "MEMBER" OF THE FOUNDATION, AS THAT TERM IS DEFINED UNDER PENNSYLVANIA LAW. IN ADDITION, THE BYLAWS OUTLINE THE FUTURE APPOINTMENT PROCESS FOR MEMBERS OF THE FOUNDATION'S BOARD OF DIRECTORS.

FORM 990, PART VI, SECTION B, LINE 11

THE FINAL VERSION OF THE 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW. INFORMATION AND ITEMS CAN BE CLARIFIED AND CONFIRMED WITH EXECUTIVE MANAGEMENT AND OTHER MEMBERS OF THE BOARD. CORRECTIONS AND CLARIFICATIONS ARE SUBMITTED OR SUGGESTED PRIOR TO THE FILING OF THE RETURN.

FORM 990, PART VI, SECTION B, LINE 12C

PERIODIC REVIEWS ARE CONDUCTED AND MAY INCLUDE ASSISTANCE FROM OUTSIDE ADVISORS TO ENSURE JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION IS OPERATING IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSE AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX EXEMPT STATUS. A DISCLOSURE PROCEDURE OUTLINED IN THE CONFLICT OF INTEREST POLICY INCLUDES SUBMISSION OF THE ANNUAL DISCLOSURE STATEMENT AS WELL AS LETTERS, MEMOS, OR OTHER DISCLOSURES TO THE BOARD. THIS PROCEDURE IS MONITORED BY OTHER MEMBERS OF THE BOARD AS WELL AS LEGAL COUNSEL. THE SCOPE OF COVERAGE FOR THE CONFLICT OF INTEREST POLICY IS DIRECTED TOWARDS "POTENTIALLY INTERESTED PARTIES" INCLUDING, BUT NOT LIMITED TO: DIRECTORS, OFFICERS, KEY EMPLOYEES, MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS, PERSONS WHO HAVE AUTHORITY TO ENTER INTO CONTRACTS OR AGREEMENTS, PERSONS WITH ACCESS TO RESTRICTED, SENSITIVE OR CONFIDENTIAL INFORMATION WHICH COULD BE VALUABLE TO NON-JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION ENTITIES, AND PERSONS WITH A SIGNIFICANT FINANCIAL INTEREST OR INFLUENTIAL INTEREST. JEFFERSON REGIONAL MEDICAL CENTER PRESIDENT & CHIEF OPERATING OFFICER, BY AUTHORITY OF THE BOARD, IS THE DESIGNATED ADMINISTRATOR FOR INTERPRETATION AND IMPLEMENTATION OF THIS POLICY AND ALL PROCEDURES RELATING TO IT. FAILURE TO COMPLY WITH THIS POLICY MAY INCLUDE A DETERMINATION FOR THE POTENTIALLY INTERESTED PARTY TO SEVER ALL TIES WITH JEFFERSON REGIONAL MEDICAL CENTER FOUNDATION.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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