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WILLIAMSON MEDICAL FOUNDATION INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
WILLIAMSON MEDICAL FOUNDATION INC (EIN 04-3717044)
Tax period
2018-07-01 to 2019-06-30
Filed
2020-02-25
IRS object ID
202010569349301456
Schema version
2018v3.1
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)
Return2020-02-25T09:32:55-06:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN621199757PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1LBMC PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1869AddressLine1Txt
CityBRENTWOODCityNm
State AbbreviationTNStateAbbreviationCd
ZIP370241869ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN043717044EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1WILLIAMSON MEDICAL CENTER FOUNDATIONINCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlWILLBusinessNameControlTxt
Phone6154355170PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14321 CAROTHERS PKWY NO 604AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationTNStateAbbreviationCd
ZIP37067ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDONALD WEBBPersonNm
Person TitleSECRETARYPersonTitleTxt
Phone6154355170PhoneNum
Signature2020-02-24SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJULIE BARTLETTPreparerPersonNm
PTINP00742923PTIN
Phone6153774600PhoneNum
Preparation2020-02-24PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address8.42.53.250IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-02-24IPDt
IP Tm10:15:12IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdD98BE2DDD66718E430DFFE5716C9C195A8F0DCEFAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-09-23 17:36:50ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDONALD WEBBPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14321 CAROTHERS PKWY SUITE 604AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationTNStateAbbreviationCd
ZIP37067ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,796,902GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.WILLIAMSONMEDICALCENTER.ORG/WMCFOUNDATIONWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateTNLegalDomicileStateCd
Activity Or MissionTHE MISSION OF WILLIAMSON MEDICAL FOUNDATION INC. IS TO SERVE AS A CHARITABLE AND DEVELOPMENT ARM TO SUPPORT WILLIAMSON MEDICAL CENTER IN PROVIDING HEALTH CARE SERVICES. TO FUND CAPITAL PROJECTS AND HEALTH OUTREACH PROGRAMS OF WILLIAMSON MEDICAL CENTER, THE FOUNDATION SEEKS CHARITABLE GIFTS OF ALL TYPES, RESTRICTED AND UNRESTRICTED.DONATIONS TO WILLIAMSON MEDICAL FOUNDATION SUPPORT PROGRAMS AND SERVICES THAT FALL OUTSIDE THE NORMAL STRUCTURE OF HOSPITAL OPERATING EXPENDITURES.GIFTS MAY BE MADE TO HONOR OR MEMORIALIZE SOMEONE, ESTABLISH OR SUPPORT A PARTICULAR FUND, PURCHASE NEW EQUIPMENT OR EXPAND OR BUILD NEW AREAS.CONTRIBUTIONS MAY COME IN MANY FORMS, INCLUDING CASH, SECURITIES, REAL ESTATE, PERSONAL PROPERTY, LIFE INSURANCE, AND WILLS AND BEQUESTS. GIFTS MAY BE SMALL OR LARGE, ANONYMOUS OR RECOGNIZED, ONE-TIME OR PLANNED OVER TIME.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,150,597PYContributionsGrantsAmt
CY Contributions Grants$1,481,362CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$50,105PYInvestmentIncomeAmt
CY Investment Income$93,578CYInvestmentIncomeAmt
PY Other Revenue$66,874PYOtherRevenueAmt
CY Other Revenue$175,918CYOtherRevenueAmt
PY Total Revenue$1,267,576PYTotalRevenueAmt
CY Total Revenue$1,750,858CYTotalRevenueAmt
PY Grants And Similar Paid$548,411PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,235,281CYGrantsAndSimilarPaidAmt
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$100,877PYOtherExpensesAmt
CY Other Expenses$129,658CYOtherExpensesAmt
PY Total Expenses$649,288PYTotalExpensesAmt
CY Total Expenses$2,364,939CYTotalExpensesAmt
PY Revenues Less Expenses$618,288PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$614,081CYRevenuesLessExpensesAmt
Total Assets BOY$4,932,621TotalAssetsBOYAmt
Total Assets EOY$4,322,040TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,932,621NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,322,040NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE MISSION OF WILLIAMSON MEDICAL FOUNDATION INC. IS TO SERVE AS A CHARITABLE AND DEVELOPMENT ARM TO SUPPORT WILLIAMSON MEDICAL CENTER IN PROVIDING HEALTH CARE SERVICES. TO FUND CAPITAL PROJECTS AND HEALTH OUTREACH PROGRAMS OF WILLIAMSON MEDICAL CENTER, THE FOUNDATION SEEKS CHARITABLE GIFTS OF ALL TYPES, RESTRICTED AND UNRESTRICTED.DONATIONS TO WILLIAMSON MEDICAL FOUNDATION SUPPORT PROGRAMS AND SERVICES THAT FALL OUTSIDE THE NORMAL STRUCTURE OF HOSPITAL OPERATING EXPENDITURES.GIFTS MAY BE MADE TO HONOR OR MEMORIALIZE SOMEONE, ESTABLISH OR SUPPORT A PARTICULAR FUND, PURCHASE NEW EQUIPMENT OR EXPAND OR BUILD NEW AREAS.CONTRIBUTIONS MAY COME IN MANY FORMS, INCLUDING CASH, SECURITIES, REAL ESTATE, PERSONAL PROPERTY, LIFE INSURANCE, AND WILLS AND BEQUESTS. GIFTS MAY BE SMALL OR LARGE, ANONYMOUS OR RECOGNIZED, ONE-TIME OR PLANNED OVER TIME.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,236,073ExpenseAmt
Grant$2,142,781GrantAmt
DescPURCHASED FURNTIURE, EQUIPMENT, AND EDUCATIONAL RESOURCE MATERIALS TO BENEFIT WILLIAMSON MEDICAL CENTER.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$92,500ExpenseAmt
Grant$92,500GrantAmt
DescPROVIDED SCHOLARSHIPS FOR STUDENTS ENROLLED IN HEALTHCARE FIELD.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$2,328,573TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc0RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldTNStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DONALD WEBBBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6154355170PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14321 CAROTHERS PARKWAY SUITE 604AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationTNStateAbbreviationCd
ZIP37067ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeInd
STARLING EVINS
CHAIRMAN8.0040.00Yes (X)Yes (X)$0$225,209$24,000
JAMEY PARKER
VICE CHAIRMAN0.30Yes (X)Yes (X)$0$0$0
LARRY WESTBROOK
TREASURER0.30Yes (X)Yes (X)$0$0$0
DON WEBB
SECRETARY0.3040.00Yes (X)Yes (X)$0$622,272$24,000
JIM LACKEY
DIRECTOR0.30Yes (X)$0$0$0
PAUL THOMAS
DIRECTOR0.30Yes (X)$0$0$0
RALPH DRURY
DIRECTOR0.30Yes (X)$0$0$0
RICHARD HERRINGTON
DIRECTOR0.30Yes (X)$0$0$0
LARRY HOUGH
DIRECTOR0.30Yes (X)$0$0$0
RUSSELL LITTLE
DIRECTOR0.30Yes (X)$0$0$0
AIMEE PUNESSEN
DIRECTOR0.30Yes (X)$0$0$0
PAMELA STEPHENS
DIRECTOR0.30Yes (X)$0$0$0
LISA NIERSTE MORRIS
DIRECTOR0.30Yes (X)$0$0$0
MARY KATE BROWN
DIRECTOR0.30Yes (X)$0$0$0
DAVID WHITE
DIRECTOR0.30Yes (X)$0$0$0
VICKI MCNAMARA
DIRECTOR0.30Yes (X)$0$0$0
R STEVE SMITH
EXECUTIVE DIRECTOR40.00$0$159,398$4,774Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,006,879TotReportableCompRltdOrgAmt
Total Other Compensation$52,774TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$1,481,362AllOtherContributionsAmt
Total Contributions$1,481,362TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$93,578TotalRevenueColumnAmt
Exclusion$93,578ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$221,962FundraisingGrossIncomeAmt
Fundraising Direct Expenses$46,044FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$175,918TotalRevenueColumnAmt
Exclusion$175,918ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,750,858TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$269,496ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$2,142,781TotalAmt
Program Services$2,142,781ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$92,500TotalAmt
Program Services$92,500ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$107,518TotalAmt
Program Services$93,292ProgramServicesAmt
Management And General$14,226ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,878TotalAmt
Management And General$2,878ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescBANK CHARGESDesc
Total$19,262TotalAmt
Management And General$19,262ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,364,939TotalAmt
Program Services$2,328,573ProgramServicesAmt
Management And General$36,366ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,772,676BOYAmt
EOY$173,674EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$783,674BOYAmt
EOY$971,265EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$757,244BOYAmt
EOY$757,244EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$323,200LandBldgEquipCostOrOtherBssAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$323,200BOYAmt
EOY$323,200EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,295,827BOYAmt
EOY$2,096,657EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,932,621BOYAmt
EOY$4,322,040EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,932,621BOYAmt
EOY$4,322,040EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,932,621BOYAmt
EOY$4,322,040EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,932,621BOYAmt
EOY$4,322,040EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$614,081ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$3,500NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit Committee0AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1WILLIAMSON MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN311702931EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$2,142,781SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$2,142,781SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$323,200InvestmentCostOrOtherBasisAmt
Book Value$323,200BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$323,200TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescMUTUAL AND EXCHANGE TRADED FUNDSDesc
Book Value$2,096,657BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$2,096,657TotalBookValueSecuritiesAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$2,194,779TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$3,500NetUnrealizedGainsInvstAmt
Other Revenue$440,421OtherRevenueAmt
Revenue Not Reported$443,921RevenueNotReportedAmt
Revenue Subtotal$1,750,858RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$1,750,858TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$2,805,360TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$440,421OtherExpensesIncludedAmt
Expenses Not Reported$440,421ExpensesNotReportedAmt
Expenses Subtotal$2,364,939ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$2,364,939TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART X, LINE 2:THE FOUNDATION IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. THE FOUNDATION HAS NO MATERIAL UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS AT JUNE 30, 2019 AND 2018. THE FOUNDATION FILES U.S. FEDERAL INFORMATION TAX RETURNS WHICH ARE CURRENTLY OPEN TO AUDIT UNDER THE STATUTE OF LIMITATIONS BY THE INTERNAL REVENUE SERVICE FOR THE YEARS ENDED AFTER JUNE 30, 2015.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RELATED PARTY SALARIES FOR SERVICES 440,421.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RELATED PARTY SALARIES FOR SERVICES 440,421.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$221,962GrossReceiptsEvent1Amt
Gross Revenue Event1$221,962GrossRevenueEvent1Amt
Cash Prizes Event1$2,900CashPrizesEvent1Amt
Non Cash Prizes Event1$1,382NonCashPrizesEvent1Amt
Rent Facility Costs Event1$16,734RentFacilityCostsEvent1Amt
Food And Beverage Event1$2,860FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$22,168OtherDirectExpensesEvent1Amt
Other Events Total1OtherEventsTotalCnt
Gross Receipts Total$221,962GrossReceiptsTotalAmt
Gross Revenue Total Events$221,962GrossRevenueTotalEventsAmt
Cash Prizes Total Events$2,900CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$1,382NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$16,734RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$2,860FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$22,168OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$46,044DirectExpenseSummaryEventsAmt
Net Income Summary$175,918NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Recipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescPurpose Of GrantPurposeOfGrantTxt
WILLIAMSON MEDICAL CENTER
621501534115$3,865CASHREIMBURSE EDUCATION EXPENSES
WILLIAMSON MEDICAL CENTER
621501534115$2,138,916CASHPURCHASE EQUIPMENT
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeFAY PORTER AWARDGrantTypeTxt
Recipient58RecipientCnt
Cash Grant$92,500CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationFUNDS ARE REQUESTED BY WILLIAMSON MEDICAL CENTER FOR A PARTICULAR PIECE OF EQUIPMENT OR EDUCATION RESOURCE. REQUESTS ARE APPROVED BY WILLIAMSON MEDICAL CENTER FOUNDATION. WILLIAMSON MEDICAL CENTER MATERIAL MANAGEMENT DIRECTOR PURCHASES THE EQUIPMENT AND THE EQUIPMENT IS PAID FOR BY WILLIAMSON MEDICAL CENTER. WILLIAMSON MEDICAL CENTER FOUNDATION IS THEN NOTIFIED THAT THE PURCHASE HAS BEEN MADE BY A COPY OF THE PURCHASE ORDER OR INVOICE. A CHECK IS ISSUED TO WILLIAMSON MEDICAL CENTER FOR THE AMOUNT OF THE EQUIPMENT BY WILLIAMSON MEDICAL CENTER FOUNDATION.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STARLING EVINS
CHAIRMAN$0$225,209$0$0$0$0$0$24,000$0$0$0$249,209$0$0
DON WEBB
SECRETARY$0$551,393$0$70,879$0$0$0$24,000$0$0$0$646,272$0$0
R STEVE SMITH
EXECUTIVE DIRECTOR$0$159,398$0$0$0$0$0$4,774$0$0$0$164,172$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE CFO OF FOUNDING MEMBER WILL REVIEW FORM 990.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC. THE 990 IS AVAILABLE ONLINE.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1WILLIAMSON MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN621501534EIN
Primary ActivitiesHOSPITALPrimaryActivitiesTxt
Legal Domicile StateTNLegalDomicileStateCd
Exempt Code Section115ExemptCodeSectionTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1WILLIAMSON COUNTY GOVERNMENTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1WILLIAMSON MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeBTransactionTypeTxt
Involved$2,142,781InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt

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