Southern New Jersey Health Information: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
Southern New Jersey Health Information (EIN 45-5469641)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-16
IRS object ID
202003219349310005
Schema version
2019v5.1
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)
Return2020-11-16T11:53:20-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

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 Begin2019-01-01TaxPeriodBeginDt

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
Signature2020-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTERRY C MONCRIEF CPAPreparerPersonNm
PTINP00065201PTIN
Phone7328423113PhoneNum
Preparation2020-11-15PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address65.124.187.43IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id22006220203215000113FederalOriginalSubmissionId
Federal Original Submission Id2020-11-16FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdF413BA53D8382AD017D67067C83213C1C57BB211AtSubmissionCreationDeviceId
At Submission Filing Device IdF413BA53D8382AD017D67067C83213C1C57BB211AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

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$292,812GrossReceiptsAmt
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$291,600CYProgramServiceRevenueAmt
PY Investment Income$261PYInvestmentIncomeAmt
CY Investment Income$1,212CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$310,713PYTotalRevenueAmt
CY Total Revenue$292,812CYTotalRevenueAmt
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$332,167PYOtherExpensesAmt
CY Other Expenses$327,344CYOtherExpensesAmt
PY Total Expenses$332,167PYTotalExpensesAmt
CY Total Expenses$327,344CYTotalExpensesAmt
PY Revenues Less Expenses-$21,454PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$34,532CYRevenuesLessExpensesAmt
Total Assets BOY$492,843TotalAssetsBOYAmt
Total Assets EOY$434,158TotalAssetsEOYAmt
Total Liabilities BOY$48,446TotalLiabilitiesBOYAmt
Total Liabilities EOY$24,293TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$444,397NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$409,865NetAssetsOrFundBalancesEOYAmt
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$288,873ExpenseAmt
Revenue$291,600RevenueAmt
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$288,873TotalProgramServiceExpensesAmt
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
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
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Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
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Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
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Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
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
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
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
RICHARD WHEATLEY
TREASURER2.00.0Yes (X)Yes (X)$0$0$0
THOMAS PACEK
PRESIDENT2.00.0Yes (X)Yes (X)$0$0$0
FRED BANNER
VICE PRESIDENT2.00.0Yes (X)Yes (X)$0$0$0
ROBERT MIZIA
SECRETARY2.00.0Yes (X)Yes (X)$0$0$0
FieldValueIRS element (for citing)
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Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
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$250,509CompensationAmt
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$291,600TotalRevenueColumnAmt
Related Or Exempt Func Income$291,600RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$291,600TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,212TotalRevenueColumnAmt
Related Or Exempt Func Income$1,212RelatedOrExemptFuncIncomeAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

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

Royalties Revenue RoyaltiesRevenueGrp

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

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

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Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

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

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$292,812TotalRevenueColumnAmt
Related Or Exempt Func Income$292,812RelatedOrExemptFuncIncomeAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

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Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

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Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

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Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

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Total$0TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Management FeesForServicesManagementGrp

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Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

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Total$16,064TotalAmt
Program Services$16,064ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$12,958TotalAmt
Management And General$12,958ManagementAndGeneralAmt

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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Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$260,809TotalAmt
Program Services$260,809ProgramServicesAmt

Advertising AdvertisingGrp

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Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,261TotalAmt
Management And General$1,261ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$12,000TotalAmt
Program Services$12,000ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
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

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Total$0TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$23,352TotalAmt
Management And General$23,352ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescSPONSORSHIPSDesc
Total$900TotalAmt
Management And General$900ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$327,344TotalAmt
Program Services$288,873ProgramServicesAmt
Management And General$38,471ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

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EOY$122,200EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

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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

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BOY$14,205BOYAmt
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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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EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

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BOY$0BOYAmt
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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
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
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Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$492,843BOYAmt
EOY$434,158EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$48,446BOYAmt
EOY$24,293EOYAmt

Grants Payable GrantsPayableGrp

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BOY$0BOYAmt
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

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Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
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Other Liabilities OtherLiabilitiesGrp

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

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$48,446BOYAmt
EOY$24,293EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$444,397BOYAmt
EOY$409,865EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$444,397BOYAmt
EOY$409,865EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$492,843BOYAmt
EOY$434,158EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$34,532ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

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

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$74,510CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$74,510TotalAmt

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$74,510CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$74,510TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$74,510PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$135CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$161CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$208CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$261CurrentTaxYearMinus1YearAmt
Current Tax Year$1,211CurrentTaxYearAmt
Total$1,976TotalAmt

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$76,486TotalSupportAmt
Gross Receipts Rltd Activities$1,747,488GrossReceiptsRltdActivitiesAmt
Public Support CY1700.97416PublicSupportCY170Pct
Public Support PY1700.99540PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 B; LINE 11BFORM 990 IS REVIEWED BY THE ORGANIZATIONS'S BOARD OF TRUSTEES BEFORE IT IS APPROVED FOR FILING.
PART VI; SECTION C; LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
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 12BNJSHINE HAS AN INFORMAL POLICY TO DISCLOSE ALL CONFLICTS AND UPDATE MANUAL FORMS PERIODICALLY AS BOARD MEMBERS CHANGE.
FORM 990 PART IX LINE 11GDESCRIPTION:EMPOLST LICENSE AGREEMENT TOTAL FEES:10300
FORM 990 PART IX LINE 11GDESCRIPTION:PROGRAM MGT CONSULTING FEES TOTAL FEES:250509

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