Southern New Jersey Health Information: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
Southern New Jersey Health Information (EIN 45-5469641)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-11-14
IRS object ID
202303189349310875
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-11-14T13:37:20-06:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1WITHUMSMITHBROWNPCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1331 NEWMAN SPRINGS RD STE 125AddressLine1Txt
CityRED BANKCityNm
State AbbreviationNJStateAbbreviationCd
ZIP077016765ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN455469641EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Southern New Jersey Health InformationBusinessNameLine1Txt
Business Name Line2OrganizationBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% RICHARD WHEATLEYInCareOfNm
Business Name ControlSOUTBusinessNameControlTxt
Phone6094632454PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 442AddressLine1Txt
CityCape May Court HouseCityNm
State AbbreviationNJStateAbbreviationCd
ZIP08210ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRICHARD WHEATLEYPersonNm
Person TitleTREASURERPersonTitleTxt
Phone6094632454PhoneNum
Signature2023-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstRICHARDPersonFirstNm
Person LastWHEATLEYPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTERRY C MONCRIEF CPAPreparerPersonNm
PTINP00065201PTIN
Phone7328423113PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRICHARD WHEATLEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 442AddressLine1Txt
CityCape May Court HouseCityNm
State AbbreviationNJStateAbbreviationCd
ZIP08210ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$466,653GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2012FormationYr
Legal Domicile StateNJLegalDomicileStateCd
Activity Or MissionTO FACILITATE ACCESS TO AND RETRIEVAL OF CLINICAL DATA AND PROVIDE THE OPPORTUNITY TO ELECTRONICALLY EXCHANGE ACCURATE CLINICAL INFORMATION BETWEEN HEALTH INFORMATION SYSTEMS.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
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CY Program Service Revenue$465,452CYProgramServiceRevenueAmt
PY Investment Income$105PYInvestmentIncomeAmt
CY Investment Income$1,201CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$238,953PYTotalRevenueAmt
CY Total Revenue$466,653CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$380,400PYOtherExpensesAmt
CY Other Expenses$465,255CYOtherExpensesAmt
PY Total Expenses$380,400PYTotalExpensesAmt
CY Total Expenses$465,255CYTotalExpensesAmt
PY Revenues Less Expenses-$141,447PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,398CYRevenuesLessExpensesAmt
Total Assets BOY$328,754TotalAssetsBOYAmt
Total Assets EOY$194,751TotalAssetsEOYAmt
Total Liabilities BOY$139,665TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,264TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$189,089NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$190,487NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPURPOSE OF NJ SHINE IS TO FACILITATE ACCESS TO AND RETRIEVAL OF CLINICAL DATA AND PROVIDE THE OPPPORTUNITY TO ELECTRONICALLY EXCHANGE ACCURATE CLINICAL INFORMATION BETWEEN HEALTH INFORMATION SYSTEMS TO IMPROVE THE COST, QUALITY, EFFICIENCY, AND EFFECTIVENESS OF PATIENT CENTERED CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$345,694ExpenseAmt
Revenue$465,452RevenueAmt
DescSUPPORT AND OPERATE A SECURE, SELF-SUSTAINING, REAL-TIME CLINICAL DATA INFORMATION EXCHANGE TO IMPROVE CARE COORDINATION, ACCESS, OUTCOMES AND EFFICIENCIES AND SERVE A COMMUNITY OF HEALTH CARE PROVIDERS TO IMPROVE QUALITY OF CARE FOR PATIENTS THROUGH ACCESS TO INTEGRATED HEALTH INFORMATION AND INFORMATION USE TECHNOLOGIES.Desc
Total Program Service Expenses$345,694TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
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Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
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School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
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Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
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Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
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Employee0EmployeeCnt
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Foreign Financial AccountfalseForeignFinancialAccountInd
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Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
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Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
DAF Excess Business HoldingsfalseDAFExcessBusinessHoldingsInd
Taxable DistributionsfalseTaxableDistributionsInd
Distribution To DonorfalseDistributionToDonorInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
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Document Retention PolicyfalseDocumentRetentionPolicyInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNJStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonRICHARD WHEATLEYPersonNm
Phone6094632454PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12 STONE HARBOR BLVDAddressLine1Txt
CityCAPE MAY COURT HOUSECityNm
State AbbreviationNJStateAbbreviationCd
ZIP08210ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
Fred Banner
PRESIDENT2.00.0Yes (X)Yes (X)$0$0$0
David Johnson
Vice PRESIDENT2.00.0Yes (X)Yes (X)$0$0$0
Jerry Vilbrun
Second VP and Secretary2.00.0Yes (X)Yes (X)$0$0$0
Richard Wheatley
Treasurer2.00.0Yes (X)Yes (X)$0$0$0
FieldValueIRS element (for citing)
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Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

FieldValueIRS element (for citing)
PersonECG MANAGEMENT CONSULTANTSPersonNm
FieldValueIRS element (for citing)
Contractor AddressContractorAddress
ServicesMANAGEMENT SERVICESServicesDesc
Compensation$238,450CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHEALTH INFORMATION EXCHANGEDesc
Business900099BusinessCd
Total Revenue Column$465,452TotalRevenueColumnAmt
Related Or Exempt Func Income$465,452RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$465,452TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,201TotalRevenueColumnAmt
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Exclusion$1,201ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
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Rental Income Or Loss RentalIncomeOrLossGrp

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Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

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Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
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Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

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Total Revenue Column$0TotalRevenueColumnAmt
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Gaming Gross Income$0GamingGrossIncomeAmt
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Net Income From Gaming NetIncomeFromGamingGrp

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Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
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Net Income Or Loss NetIncomeOrLossGrp

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Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
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Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$466,653TotalRevenueColumnAmt
Related Or Exempt Func Income$465,452RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,201ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

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Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

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Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

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Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

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Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

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Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

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Other Employee Benefits OtherEmployeeBenefitsGrp

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Total$0TotalAmt

Payroll Taxes PayrollTaxesGrp

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Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

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Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$12,851TotalAmt
Program Services$12,851ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$5,360TotalAmt
Management And General$5,360ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

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Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

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Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

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Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$323,450TotalAmt
Program Services$323,450ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,411TotalAmt
Management And General$2,411ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$9,393TotalAmt
Program Services$9,393ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

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Total$0TotalAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

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Total$0TotalAmt

Interest InterestGrp

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Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$110,740TotalAmt
Management And General$110,740ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescSPONSORSHIPSDesc
Total$1,050TotalAmt
Management And General$1,050ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
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Program Services$345,694ProgramServicesAmt
Management And General$119,561ManagementAndGeneralAmt
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FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

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EOY$2,695EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

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Accounts Receivable AccountsReceivableGrp

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Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

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Inventories For Sale Or Use InventoriesForSaleOrUseGrp

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Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
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Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

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BOY$0BOYAmt
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Investments Pub Traded Sec InvestmentsPubTradedSecGrp

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Investments Other Securities InvestmentsOtherSecuritiesGrp

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Investments Program Related InvestmentsProgramRelatedGrp

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BOY$0BOYAmt
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Intangible Assets IntangibleAssetsGrp

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BOY$0BOYAmt
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Other Assets Total OtherAssetsTotalGrp

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Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$328,754BOYAmt
EOY$194,751EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

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EOY$4,264EOYAmt

Grants Payable GrantsPayableGrp

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EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

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Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

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Escrow Account Liability EscrowAccountLiabilityGrp

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Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
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Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
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Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
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EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$139,665BOYAmt
EOY$4,264EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$189,089BOYAmt
EOY$190,487EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$189,089BOYAmt
EOY$190,487EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$328,754BOYAmt
EOY$194,751EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,398ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
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Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$0PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$261CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,212CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$805CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$105CurrentTaxYearMinus1YearAmt
Current Tax Year$1,201CurrentTaxYearAmt
Total$3,584TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$3,584TotalSupportAmt
Gross Receipts Rltd Activities$1,525,052GrossReceiptsRltdActivitiesAmt
Public Support CY1700.00000PublicSupportCY170Pct
Public Support PY1700.96640PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests PY170Yes (X)ThirtyThrPctSuprtTestsPY170Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$310,452CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$291,600CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$218,700CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$238,848CurrentTaxYearMinus1YearAmt
Current Tax Year$465,452CurrentTaxYearAmt
Total$1,525,052TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$310,452CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$291,600CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$218,700CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$238,848CurrentTaxYearMinus1YearAmt
Current Tax Year$465,452CurrentTaxYearAmt
Total$1,525,052TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$1,525,052PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$261CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,212CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$805CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$105CurrentTaxYearMinus1YearAmt
Current Tax Year$1,201CurrentTaxYearAmt
Total$3,584TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$261CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,212CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$805CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$105CurrentTaxYearMinus1YearAmt
Current Tax Year$1,201CurrentTaxYearAmt
Total$3,584TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$310,713CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$292,812CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$219,505CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$238,953CurrentTaxYearMinus1YearAmt
Current Tax Year$466,653CurrentTaxYearAmt
Total$1,528,636TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99765PublicSupportCY509Pct
Public Support PY5090.00000PublicSupportPY509Pct
Investment Income CY0.00234InvestmentIncomeCYPct
Investment Income PY0.00000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART VI; SECTION A; LINE 6THE ORGANIZATION CONSISTS OF 3 FOUNDING MEMBERS WHO ARE HOSPITALS AND HEALTH SYSTEMS WHO ENTERED INTO A MEMBERSHIP PARTICIPATION AGREEMENT WITH THE CORPORATION.
PART VI; SECTION A; LINE 7A & 7BEACH OF THE ORGANIZATION'S MEMBERS HAVE THE RIGHT TO APPOINT THE PERSON THAT WILL SERVE AS THE REPRESENTATIVE BOARD OF TRUSTEE FOR THE MEMBER. CERTAIN RIGHTS AND POWERS RELATED TO MEMBERSHIP, APPOINTMENT OF TRUSTEES, AMENDMENT OF THE BY-LAWS OR CERTIFICATION OF INCORPORATION, CORPORATIONS FUNCTION, MISSION, EXISTENCE OR APPROVAL TO BORROW FUNDS OF $20,000 OR MORE ARE RESERVED TO THE MEMBERS AND ARE DOCUMENTED IN THE ORGANIZATIONS BY-LAWS.
PART VI; SECTION B, LINE 11BFORM 990 IS REVIEWED BY THE ORGANIZATIONS'S BOARD OF TRUSTEES BEFORE IT IS APPROVED FOR FILING.
PART VI; SECTION B, LINE 12BNJSHINE HAS AN INFORMAL POLICY TO DISCLOSE ALL CONFLICTS AND UPDATE MANUAL FORMS PERIODICALLY AS BOARD MEMBERS CHANGE.
PART VI; SECTION B; LINE 12CPERIODIC REVIEWS ARE CONDUCTED TO ENSURE CONFLICTS OF INTEREST, ACTUAL, APPARENT OR POTENTIAL, ARE FULLY DISCUSSED AND DISCLOSED WITH THE BOARD OF TRUSTEES.
PART VI; SECTION C; LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990 PART IX LINE 11GDESCRIPTION:OUTSIDE CONTRACT SERVICES TOTAL FEES:85000
FORM 990 PART IX LINE 11GDESCRIPTION:PROJECT MANAGEMENT SERVICES TOTAL FEES:238450

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