2016-09-22T16:22:29-05:00 2015-12-31 204193611 Batts Morrison Wales and Lee PA 801 North Orange Avenue Suite 800 Orlando FL 32801 990 2015-01-01 471487930 Grace Medical Home Foundation Inc GRAC 4079362785 51 Pennsylvania Street Orlando FL 32806 Leigh Ann Horton Treasurer 4079362785 2016-09-06 1 Julia W James P01772503 4077706000 2016-09-06 2015 2017-02-10 21:41:12Z Stephanie Garris 51 Pennsylvania Street Orlando FL 32806 778507 0 X N/A X 2014 FL The Organization supports and furthers the interests of Grace Medical Home, Inc., a Florida not-for-profit corporation that is exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code. 3 2 0 0 0 0 0 775000 0 0 0 3507 0 0 0 778507 0 0 0 0 0 0 0 0 2156 0 23304 0 23304 0 755203 0 755203 0 0 0 755203 X The Organization operates exclusively for the benefit of Grace Medical Home, Inc. (the "Supported Organization") by raising, holding, investing and spending cash and assets convertible into cash for the benefit of or on behalf of the Supported Organization. The Organization owns property, including real property, tangible and intangible property, to be operated, invested and otherwise used for the benefit of or on behalf of the Supported Organization. 0 0 11955 0 0 The Organization provides supporting services to Grace Medical Home, Inc., a public charity under Section 501(c)(3) of the Internal Revenue Code, by pursuing and administering both traditional donations and non-traditional donations such as real estate, charitable gift annuities, charitable remainder trusts, endowment funds, and other types of planned giving vehicles. 11955 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 FL X Stephanie Garris 4079362785 51 Pennsylvania Street Orlando FL 32806 Leigh Ann Horton Treasurer/Director 1.00 2.00 X X 0 0 0 Cynthia Wood Director 1.00 2.00 X 0 0 0 Rick Fletcher Director 1.00 0.00 X 0 0 0 Stephanie Garris President & Secretary 2.00 45.00 X 0 85733 22250 0 85733 22250 0 0 0 0 0 775000 775000 3507 3507 778507 0 0 3507 3659 3183 220 256 3034 3034 150 150 Service Agreement Cost 14460 7084 5612 1764 General Overhead 1940 1688 116 136 Taxes & Licenses 61 61 23304 11955 9193 2156 0 755203 0 755203 0 0 X 0 0 0 0 0 755203 0 755203 0 755203 755203 0 X 0 0 0 X X X 1 Grace Medical Home Inc 261817966 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Schedule A, Part IV, Section C, Line 1 The Organization is supervised and controlled by Grace Medical Home, Inc. ("GMH") in that a majority of the members of the Organization's Board of Directors are required to be members of GMH's Board of Directors per the Organization's bylaws. The Organization's Board of Directors is appointed by its sole corporate member, Grace Medical Nominating Trust, a trust formed for the sole purpose of appointing the board members of both GMH and this Organization. Therefore, the control of the Organization is vested in the same person that controls the publicly supported organization, GMH. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED Form 990, Part VI, Section A, line 6 The Organization's sole member is Grace Medical Nominating Trust. Form 990, Part VI, Section A, line 7a Directors are selected by the Organization's sole member, Grace Medical Nominating Trust. Form 990, Part VI, Section B, line 11 The Organization's top management official and top financial official each review the Form 990 prior to its filing with the IRS. A copy of the final Form 990 is also provided to the voting members of the Organization's governing body prior to its filing with the IRS. Form 990, Part VI, Section B, line 12c The Organization's conflict of interest policy is distributed to each member of the Organization's governing body, its officers and its key employees on an annual basis. Each such individual provides an annual disclosure statement indicating that they have received, read, understood and agreed to comply with the policy, certifying that: (1) they have no relationships or interests that present a conflict of interest, (2) they have one or more conflicts of interest that have been fully disclosed as required by the policy and have been properly administered in conformity with the policy, or (3) they have previously undisclosed conflicts of interest and disclosing the details of such conflicts. Any disclosure statements with previously undisclosed conflicts of interest are forwarded to appropriate Organization officials to take appropriate actions as required by the policy. Form 990, Part VI, Section B, line 15 The Organization does not have any paid employees and therefore does not have a compensation setting policy. Key personnel supporting the Organization are employees of Grace Medical Home, Inc., a related tax-exempt organization. Grace Medical Home, Inc. has adopted an executive compensation setting policy applicable to all disqualified persons, including the Organization's CEO, officers and key employees. Under the policy, an independent committee of the Board of Directors annually reviews and approves the compensation levels of all individuals subject to the policy. The deliberations and decisions of the committee are contemporaneously substantiated. The committee utilizes comparability data in its deliberations; updated comparability data is generally obtained every two to three years. Form 990, Part VI, Section C, line 19 The Organization provides, upon request, copies of its Articles of Incorporation, bylaws, conflict of interest policy, and its financial statements. Grace Medical Home Inc 51 Pennsylvania Street Orlando FL 32806 261817966 To reflect Christ by offering medical care to those who need it most FL 501(c)(3) Line 3 Grace Medical Nominating Trust 0 Grace Medical Nominating Trust 51 Pennsylvania Street Orlando FL 32806 Appointing and removing the filing Organization's board members FL N/A T 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 Grace Medical Home Inc C 775000 Cash Part IV, Additional Information Grace Medical Nominating Trust ("the Trust") is the sole member of Grace Medical Home Foundation, Inc. The Trust exists solely to nominate, appoint, remove, and replace members of the board of directors of the filing Organization and its related organization, Grace Medical Home Inc. The Trust does not have any financial activity and has not obtained an employer identification number; nor is it required to file a federal tax return.