JOHNSON COUNTY HEALTH FOUNDATION INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
JOHNSON COUNTY HEALTH FOUNDATION INC (EIN 35-1635296)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-15
IRS object ID
201613209349313876
Schema version
2015v2.1
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)
Return2016-11-15T15:57:00-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN352140590PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1HASH CPA GROUP LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 637AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP461310637ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351635296EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHNSON COUNTY HEALTH FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlJOHNBusinessNameControlTxt
Phone3177362657PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 549AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP461310549ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDOUG STEWARTPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone3177362657PhoneNum
Signature2016-11-10SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDENNIS J HASHPreparerPersonNm
PTINP00381730PTIN
Phone3177382366PhoneNum
Preparation2016-11-10PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1JOHNSON MEMORIAL HOSPITAL FDNBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDOUG STEWARTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 549AddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP46131ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$919,533GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1985FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTO RAISE CHARITABLE FUNDS TO BENEFIT JOHNSON MEMORIAL HOSPITAL IN IMPROVING THE HEALTH OF OUR COMMUNITYActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers35TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$51,509PYContributionsGrantsAmt
CY Contributions Grants$63,779CYContributionsGrantsAmt
PY Program Service Revenue$24,688PYProgramServiceRevenueAmt
CY Program Service Revenue$15,023CYProgramServiceRevenueAmt
PY Investment Income$151,978PYInvestmentIncomeAmt
CY Investment Income$130,976CYInvestmentIncomeAmt
PY Other Revenue$29,270PYOtherRevenueAmt
CY Other Revenue$27,876CYOtherRevenueAmt
PY Total Revenue$257,445PYTotalRevenueAmt
CY Total Revenue$237,654CYTotalRevenueAmt
PY Grants And Similar Paid$89,415PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$78,363CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$2,349CYTotalFundraisingExpenseAmt
PY Other Expenses$168,423PYOtherExpensesAmt
CY Other Expenses$188,090CYOtherExpensesAmt
PY Total Expenses$257,838PYTotalExpensesAmt
CY Total Expenses$266,453CYTotalExpensesAmt
PY Revenues Less Expenses-$393PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$28,799CYRevenuesLessExpensesAmt
Total Assets BOY$1,797,909TotalAssetsBOYAmt
Total Assets EOY$1,566,771TotalAssetsEOYAmt
Total Liabilities BOY$2,928TotalLiabilitiesBOYAmt
Total Liabilities EOY$20,756TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,794,981NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,546,015NetAssetsOrFundBalancesEOYAmt
MissionTO RAISE CHARITABLE FUNDS TO BENEFIT JOHNSON MEMORIAL HOSPITAL IN IMPROVING THE HEALTH OF OUR COMMUNITYMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$68,394ExpenseAmt
Grant$59,093GrantAmt
DescNURSING SCHOLARSHIPS AND EDUCATION GRANTS FOR 29 RECIPIENTS, AND FUNDING FOR HOSPITAL EDUCATION REIMBURSEMENT PROGRAM ASSISTED 31 EMPLOYEESDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$122,220ExpenseAmt
Grant$19,270GrantAmt
DescSUPPORT OF HEALTHIER COMMUNITY PROGRAMS AND SERVICES, INCLUDING TO PROMOTE AND SUPPORT SERVICES OF THE HOSPITAL AND AFFILIATES, AND ASSIST DEPARTMENTS WITH NEW TECHNOLOGY UPDATES. PROVIDE HOSPITAL STAFF WITH INFORMATION AND RESOURCES FOR PROMOTING HEALTHY LIVING AND PROVIDING QUALITY CARE. PROMOTE AWARENESS, CARING, AND UNITY AMONG HOSPITAL STAFF. PROMOTE LOCAL ORGANIZATIONS THAT PROVIDE PROGRAMS FOR HEALTHY FAMILIES, SCHOOL, AND REHAB SERVICES.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$31,217ExpenseAmt
Revenue$15,023RevenueAmt
DescBEGAN WORKING WITH COMMUNITY LEADERS IN 2014 TO SERVE AS FISCAL AGENT FOR WOMENS OUTDOOR WELLNESS CHALLENGE TRIP. THIS ANNUAL WEEK LONG ADVENTURE TRIP IS AVAILABLE TO ALL WOMEN, AND PROVIDES A WEEK OF ORGANIZED OUTDOOR ACTIVITIES TO MOTIVATE AND ENCOURAGE HEALTHY LIFESTYLES. BY SERVING AS THE FISCAL AGENT, WE GENERATE AWARENESS OF THE FOUNDATION'S MISSION AND DEVELOP RELATIONSHIPS THAT CULTIVATE FUTURE DONORS AND CONNECT WITH CURRENT DONORS. IN AUGUST 2015, 54 WOMAN PARTICIPATED IN THE WELLNESS TRIP TO GEORGIA. DURING THE TRIP AN INFORMAL PRESENTATION ABOUT THE FOUNDATION WAS GIVEN. AFTERWARDS, APPROXIMATELY 50 WOMAN REGISTERED TO PARTICIPATE IN THE AUGUST 2016 TRIP TO OREGON.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$221,831TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundYes (true)DonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
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 With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
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
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
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 PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJENNIFER PRICE-TENNELLPersonNm
Phone3177362657PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11125 W JEFFERSON STAddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP46131ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
JERRY ENGLE
DIRECTOR1.002.00Yes (X)$0$0$0
JOHN W AULD JR
DIRECTOR1.00Yes (X)$0$0$0
JEFFREY OWEN
DIRECTOR1.00Yes (X)$0$0$0
DAVID DUNKLE MD
V.P.1.00Yes (X)$0$0$0Yes (X)
SANDI HUDDLESTON
DIRECTOR1.002.00Yes (X)$0$0$0
JOHN NORRIS MD
DIRECTOR1.00Yes (X)$0$0$0
LARRY HEYDON
SECRETARY/TR1.00Yes (X)$0$0$0Yes (X)
LYNN GRAY
DIRECTOR1.00Yes (X)$0$0$0
DOUG STEWART
PRESIDENT1.00Yes (X)$0$0$0Yes (X)
DAVID WIPPERMANN MD
DIRECTOR1.00Yes (X)$0$0$0
TOM THOMPSON
DIRECTOR1.00Yes (X)$0$0$0
JANE BLESSING
EXECUTIVE DI14.0026.00$0$94,126$9,330Yes (X)
FieldValueIRS element (for citing)
Tot Reportable Comp Rltd Org$94,126TotReportableCompRltdOrgAmt
Total Other Compensation$9,330TotalOtherCompensationAmt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Fundraising$322FundraisingAmt
All Other Contributions$63,457AllOtherContributionsAmt
Total Contributions$63,779TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescWOMENS OUTDOOR WELLNESSDesc
Business900099BusinessCd
Total Revenue Column$15,023TotalRevenueColumnAmt
Exclusion$15,023ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$15,023TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$47,266TotalRevenueColumnAmt
Exclusion$47,266ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$747,264SecuritiesAmt
Other$1,082OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$664,636SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$82,628SecuritiesAmt
Other$1,082OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$83,710TotalRevenueColumnAmt
Related Or Exempt Func Income$82,630RelatedOrExemptFuncIncomeAmt
Exclusion$1,080ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$45,119FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$322ContriRptFundraisingEventAmt
Fundraising Direct Expenses$17,243FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$27,876TotalRevenueColumnAmt
Exclusion$27,876ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$237,654TotalRevenueColumnAmt
Related Or Exempt Func Income$82,630RelatedOrExemptFuncIncomeAmt
Exclusion$91,245ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$17,415TotalAmt
Program Services$17,415ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$60,948TotalAmt
Program Services$60,948ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$114,800TotalAmt
Program Services$89,544ProgramServicesAmt
Management And General$22,960ManagementAndGeneralAmt
Fundraising$2,296FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$4,765TotalAmt
Program Services$2,379ProgramServicesAmt
Management And General$2,386ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$23,974TotalAmt
Program Services$8,280ProgramServicesAmt
Management And General$15,694ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$879TotalAmt
Program Services$499ProgramServicesAmt
Management And General$380ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$2,631TotalAmt
Program Services$2,052ProgramServicesAmt
Management And General$526ManagementAndGeneralAmt
Fundraising$53FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
WOMENS OUTDOOR WELLNESS$31,217$31,217
REFLECTION GARDEN EXPENSE$4,348$4,348
POOH BEAR EXPENSE$2,405$2,405
CATERING$1,633$1,306$327

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,438TotalAmt
Program Services$1,438ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$266,453TotalAmt
Program Services$221,831ProgramServicesAmt
Management And General$42,273ManagementAndGeneralAmt
Fundraising$2,349FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$29,033BOYAmt
EOY$11,504EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,719LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,719LandBldgEquipAccumDeprecAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,646,532BOYAmt
EOY$1,425,472EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$122,344BOYAmt
EOY$129,795EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,797,909BOYAmt
EOY$1,566,771EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,928BOYAmt
EOY$1,731EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$19,025EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,928BOYAmt
EOY$20,756EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,521,991BOYAmt
EOY$1,270,784EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$163,990BOYAmt
EOY$166,231EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$109,000BOYAmt
EOY$109,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,794,981BOYAmt
EOY$1,546,015EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,797,909BOYAmt
EOY$1,566,771EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$28,799ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$220,167NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

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 Line1JOHNSON MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN351166081EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$43,259SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$43,259SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

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

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSUPPLEMENTAL INFORMATIONFormAndLineReferenceDesc
ExplanationDURING THE TAX YEAR, THE JOHNSON COUNTY HEALTH FOUNDATION SUPPORTED JOHNSON MEMORIAL HOSPITAL BY SUPPORTING THE STAFF AND PROVIDING OTHER OPERATIONS SUPPORT. THEY ALSO ADMINISTERED FUNDS TO UPDATE HOSPITAL DEPARTMENTS AND AFFILIATES WITH NEW EQUIPMENT AND TECHNOLOGY TO PROVIDE QUALITY CARE.ExplanationTxt

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

FieldValueIRS element (for citing)
Donor Advised Funds Held1DonorAdvisedFundsHeldCnt
Funds And Other Accounts Held9FundsAndOtherAccountsHeldCnt
Donor Advised Funds Contri$22,415DonorAdvisedFundsContriAmt
Funds And Other Accounts Contri$17,292FundsAndOtherAccountsContriAmt
Donor Advised Funds Grants$23,000DonorAdvisedFundsGrantsAmt
Funds And Other Accounts Grants$45,994FundsAndOtherAccountsGrantsAmt
Donor Advised Funds Vl EOY$34,338DonorAdvisedFundsVlEOYAmt
Funds And Other Accounts Vl EOY$1,011,440FundsAndOtherAccountsVlEOYAmt
Disclosed Org Leg CtrlfalseDisclosedOrgLegCtrlInd
Disclosed For Charitable PrpsYes (true)DisclosedForCharitablePrpsInd

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,719OtherCostOrOtherBasisAmt
Depreciation$4,719DepreciationAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
JCCF ENDOWMENT - GENERAL FD$69,687
JCCF ENDOWMENT - MORGAN TR$51,512
PREPAID EXPENSE - WOW TRIP$7,495
JMH EMPLOYEE RECEIVABLE$1,101
FieldValueIRS element (for citing)
Total Book Value Other Assets$129,795TotalBookValueOtherAssetsAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$45,441GrossReceiptsEvent1Amt
Charitable Contri Event1$322CharitableContriEvent1Amt
Gross Revenue Event1$45,119GrossRevenueEvent1Amt
Cash Prizes Event1$2,200CashPrizesEvent1Amt
Non Cash Prizes Event1$6,452NonCashPrizesEvent1Amt
Rent Facility Costs Event1$3,840RentFacilityCostsEvent1Amt
Food And Beverage Event1$4,462FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$289OtherDirectExpensesEvent1Amt
Gross Receipts Total$45,441GrossReceiptsTotalAmt
Charitable Contributions Tot$322CharitableContributionsTotAmt
Gross Revenue Total Events$45,119GrossRevenueTotalEventsAmt
Cash Prizes Total Events$2,200CashPrizesTotalEventsAmt
Non Cash Prizes Total Events$6,452NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$3,840RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$4,462FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$289OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$17,243DirectExpenseSummaryEventsAmt
Net Income Summary$27,876NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHNSON MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11125 W JEFFERSONAddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP46131ZIPCd
FieldValueIRS element (for citing)
Recipient EIN351166081RecipientEIN
Cash Grant$13,311CashGrantAmt
Purpose Of GrantOPERATIONS / DEPT.PurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (5 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
RELATED FIELD24$23,000
PURSUING NURSING DEGREE5$8,000
DEGREE / NURSE PROF. DEV.31$28,093
MEDICAL EXPENSE ASSIST.1$55
TECHNOLOGY TRAINING1$1,800

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION REVIEWS APPLICATIONS TO DETERMINE WHICH SCHOLARSHIP RECIPIENTS WOULD MOST BE IN LINE WITH THE ORGANIZATION'S MISSION. ONCE SCHOLARSHIPS ARE AWARDED, THE CHECKS ARE WRITTEN DIRECTLY TO THE SCHOOL TO GUARANTEE THAT FUNDS ARE USED FOR THEIR INTENDED PURPOSE. THE ORGANIZATION WORKS CLOSELY WITH ST THOMAS CLINIC AND THE JOHNSON MEMORIAL HOSPITAL AND CAN OBSERVE THE PROGRAMS FIRST HAND.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS DISTRIBUTED TO ALL BOARD MEMBERS WHEN COMPLETE. WHEN THE BOARD MEMBERS ARE SATISFIED WITH ITS CONTENT, THE RETURN IS FILED.
FORM 990, PAGE 6, PART VI, LINE 12CSITUATIONS THAT GIVE RISE TO POSSIBLE CONFLICTS OF INTEREST ARE DISCUSSED AS THEY OCCUR TO DETERMINE THE BEST COURSE OF ACTION. EACH BOARD MEMBER COMPLETES AN ANNUAL CONFLICT OF INTEREST STATEMENT.
FORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1JOHNSON MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11125 W JEFFERSONAddressLine1Txt
CityFRANKLINCityNm
State AbbreviationINStateAbbreviationCd
ZIP46131ZIPCd
FieldValueIRS element (for citing)
EIN351166081EIN
Primary ActivitiesCO HOSPITAPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code SectionGOVTExemptCodeSectionTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

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