ROCKBRIDGE COMMUNITY HEALTH FOUNDATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- ROCKBRIDGE COMMUNITY HEALTH FOUNDATION (EIN 20-3592795)
- Tax period
- 2019-10-01 to 2020-09-30
- Filed
- 2021-08-13
- IRS object ID
- 202112259349301436
- Schema version
- 2019v5.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-13T11:09:14-05:00 | ReturnTs |
| Tax Period End | 2020-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 842703541 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IMLER & IMLER CPAS PLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 CROSSING LANE SUITE 103 | AddressLine1Txt |
| City | LEXINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203592795 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SJH COMMUNITY HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SJHC | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HEALTH CIRCLE | AddressLine1Txt |
| City | LEXINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24450 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PHILIP GIBSON | PersonNm |
| Person Title | VICE CHAIR | PersonTitleTxt |
| Signature | 2021-07-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TRACY N IMLER CPA | PreparerPersonNm |
| PTIN | P00823775 | PTIN |
| Phone | 5404583847 | PhoneNum |
| Preparation | 2021-08-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PHILIP GIBSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 232 BARES WOODS LANE | AddressLine1Txt |
| City | LEXINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,734,234 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2005 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH, WELFARE, AND EDUCATION OF THE RESIDENTS OF THE SERVICE AREAS OF STONEWALL JACKSON HOSPITAL | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,324 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,548 | CYProgramServiceRevenueAmt |
| PY Investment Income | $40,968 | PYInvestmentIncomeAmt |
| CY Investment Income | $88,485 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $61,292 | PYTotalRevenueAmt |
| CY Total Revenue | $106,033 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $73,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,827 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,560 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,883 | PYOtherExpensesAmt |
| CY Other Expenses | $8,858 | CYOtherExpensesAmt |
| PY Total Expenses | $86,710 | PYTotalExpensesAmt |
| CY Total Expenses | $12,418 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$25,418 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $93,615 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,990,321 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,027,346 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $153 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,990,168 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,027,346 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE HEALTH, WELFARE, AND EDUCATION OF THE RESIDENTS OF THE SERVICE AREAS OF STONEWALL JACKSON HOSPITAL | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $5,292 | ExpenseAmt |
| Revenue | $17,548 | RevenueAmt |
| Desc | GRANT TO SUPPORT STONEWALL JACKSON HOSPITAL | Desc |
| Total Program Service Expenses | $5,292 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 1 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA COLEMAN | PersonNm |
| Phone | 5404583596 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 HEALTH CIRCLE | AddressLine1Txt |
| City | LEXINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 24450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| ANNA CROCKETT | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| D CLAYTON DEVENING JR DDS | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PHILIP GIBSON | ||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ROBERT J HOBBS | ||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| ROBERT HUCH | ||||||
| SEC/TREASURE | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| KAREN JACKSON | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| AYESHA J KELLY MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DAPHNE A STICKLEY | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SHERI WILCOX | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CLIFTON FORGE | Desc |
| Total Revenue Column | $17,548 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,548 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,548 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,254 | TotalRevenueColumnAmt |
| Exclusion | $18,254 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,698,432 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,628,201 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $70,231 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,231 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $70,231 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $106,033 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $87,779 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $18,254 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,378 | TotalAmt |
| Management And General | $3,378 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182 | TotalAmt |
| Management And General | $182 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,190 | TotalAmt |
| Management And General | $1,190 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,762 | TotalAmt |
| Management And General | $1,762 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $614 | TotalAmt |
| Management And General | $614 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,484 | TotalAmt |
| Program Services | $2,484 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,808 | TotalAmt |
| Program Services | $2,808 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,418 | TotalAmt |
| Program Services | $5,292 | ProgramServicesAmt |
| Management And General | $7,126 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,598 | BOYAmt |
| EOY | $96,145 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $829,705 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,466 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $817,047 | BOYAmt |
| EOY | $814,239 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,367,260 | BOYAmt |
| EOY | $1,324,546 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,792,416 | BOYAmt |
| EOY | $4,792,416 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,990,321 | BOYAmt |
| EOY | $7,027,346 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,990,168 | BOYAmt |
| EOY | $7,027,346 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,990,168 | BOYAmt |
| EOY | $7,027,346 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,990,321 | BOYAmt |
| EOY | $7,027,346 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $93,615 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$56,437 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | false | FSAuditedInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARILION STONEWALL JACKSON HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 203592795 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | false | TimelyProvidedDocumentsInd |
| Officers Close Relationship | false | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (true) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (true) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (true) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION D, LINE 2 | THE SUPPORTED ORGANIZATION HAS SIGNIFICANT INVOLVEMENT IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME AND ASSETS. MAJOR ASSETS OF THE FOUNDATION CONSIST OF A 20% INTEREST IN THE SUPPORTED ORGANIZATION, REAL ESTATE CONTROLLED BY THAT SUPPORTED ORGANIZATION, AND AN INVESTMENT FUND THAT IS MANAGED BY THE SUPPORTED ORGANIZATION. THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF THE FOUNDATION ALSO STATE IN ARTICLE II THAT ALL INCOME OVER AND ABOVE THE NECESSARY EXPENSES AND RESERVES IS TO BE TURNED OVER TO THE HOSPITAL, THE SUPPORTED ORGANIZATION. |
| PART IV, SECTION D, LINE 3 | THE SUPPORTED ORGANIZATION HAS SIGNIFICANT INVOLVEMENT IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME AND ASSETS. MAJOR ASSETS OF THE FOUNDATION CONSIST OF A 20% INTEREST IN THE SUPPORTED ORGANIZATION, REAL ESTATE CONTROLLED BY THAT SUPPORTED ORGANIZATION, AND AN INVESTMENT FUND THAT IS MANAGED BY THE SUPPORTED ORGANIZATION. THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF THE FOUNDATION ALSO STATE IN ARTICLE II THAT ALL INCOME OVER AND ABOVE THE NECESSARY EXPENSES AND RESERVES IS TO BE TURNED OVER TO THE HOSPITAL, THE SUPPORTED ORGANIZATION. |
| PART IV, SECTION E, LINE 2A | THE ORGANIZATION'S ACTIVITIES DIRECTLY FURTHERED THE EXEMPT PURPOSE OF THE SUPPORTED ORGANIZATION BY PROMOTING HEALTH AND THE EDUCATION OF HEALTH IN THE COMMUNITY. |
| PART IV, SECTION E, LINE 2B | THE ORGANIZATION ENGAGED IN ACTIVITIES THAT THE SUPPORTED ORGANIZATION WOULD HAVE OTHERWISE ENGAGED IN THEMSELVES IN ORDER TO PROMOTE HEALTH AND THE EDUCATION OF HEALTH IN THE COMMUNITY. |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $722,128 | OtherCostOrOtherBasisAmt |
| Book Value | $722,128 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $722,128 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | 20% INTEREST IN CSJH | Desc |
| Book Value | $4,792,416 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,792,416 | TotalBookValueOtherAssetsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 11B | ALL BOARD MEMBERS ARE PROVIDED A DRAFT COPY OF THE 990 AND GIVEN THE OPPORTUNITY TO REVIEW ALL FORMS AND PROVIDE FEEDBACK PRIOR TO THE FILING OF THE 990 |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANY POSSIBLE OR ACTUAL CONFLICT OF INTEREST ON THE PART OF ANY DIRECTOR OR OFFICER IN ANY MATTER INVOLVING THE ORGANIZATION IS REQUIRED TO BE DISCLOSED TO THE BOARD AT OR BEFORE THE MEETING AT WHICH THE MATTER IS CONSIDERED. CONFLICTS OF INTEREST ARE REQUIRED TO BE HANDLED IN ACCORDANCE WITH APPLICABLE LAWS AND REGULATIONS AND THE TERMS OF ANY CONFLICTS OF INTEREST POLICY ADOPTED BY THE ORGANIZATION. THE MINUTES OF ANY MEETING AT WHICH THE BOARD SHALL CONSIDER A MATTER INVOLVING A CONFLICT OF INTEREST OF ANY DIRECTOR OR OFFICER SHALL REFLECT DISCLOSURE OF SUCH CONFLICT, AND ALL PERTINENT ACTIONS RELATING THERETO. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST |
| FORM 990, PART XI, LINE 9 | UNREALIZED LOSS ON INVESTMENT -56,437 |
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