Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ANMED HEALTH FOUNDATION
Employer identification number
57-0817544
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
920,012
1,228,305
859,562
585,647
827,439
4,420,965
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
920,012
1,228,305
859,562
585,647
827,439
4,420,965
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
71,480
6
Public Support. Subtract line 5 from line 4.
4,349,485
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
920,012
1,228,305
859,562
585,647
827,439
4,420,965
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
59,290
41,436
11,606
2,492
2,201
117,025
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
4,537,990
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
95.850 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
96.300 %
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ANMED HEALTH FOUNDATION
Employer identification number
57-0817544
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
THE ORGANIZATION SHARES ITS MANAGEMENT OVERSIGHT WITH ANMED HEALTH, A RELATED ORGANIZATION. ON OCTOBER 1, 2009, THE HOSPITAL SYSTEM ENTERED INTO A SERVICES AND AFFILIATION AGREEMENT WITH THE CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM (CHS). THE AGREEMENT APPOINTS CAROLINAS HEALTHCARE SYSTEM AS THE MANAGER OF THE HOSPITAL SYSTEM. THE BOARD OF ANMED HEALTH CONTINUES TO OVERSEE THE OPERATIONS OF THE HEALTHCARE FACILITY AND RELATED EXEMPT ACTIVITIES. AS PART OF THE AGREEMENT, ANMED HEALTH GRANTS CHS THE RESPONSIBILITY FOR MANAGEMENT OF THE HEALTH SYSTEM, SUBJECT TO THE GENERAL APPROVAL OF THE BOARD OF DIRECTORS OF ANMED HEALTH. BOARD APPROVAL IS REQUIRED FOR LARGE CAPITAL EXPENDITURES, SALE OR DISPOSAL OF SYSTEM ASSETS, AND BORROWING IN EXCESS OF IMMATERIAL AMOUNTS. CHS IS REQUIRED TO PROVIDE KEY MANAGEMENT PERSONNEL; HOWEVER, THE CURRENT CEO, CFO, AND A NUMBER OF KEY EMPLOYEES ARE PERSONS THAT WERE FORMERLY EMPLOYED DIRECTLY BY ANMED HEALTH, PRIOR TO THE EFFECTIVE DATE OF THE AGREEMENT.
FORM 990, PART VI, SECTION B, LINE 11
THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION AND REVIEW BY MANAGEMENT, THE RETURN WAS EMAILED TO EACH VOTING MEMBER OF THE BOARD AND PLACED ON A SECURE WEBSITE PRIOR TO THE JULY 2012 BOARD MEETING. AT THE MEETING, BOARD MEMBERS HAD AN OPPORTUNITY TO DISCUSS THE RETURN AND ASK QUESTIONS OF THE CFO AND A REPRESENTATIVE OF THE ACCOUNTING FIRM.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION SHARES ITS CONFLICT OF INTEREST POLICY AND PROCEDURES WITH ANMED HEALTH, A RELATED ORGANIZATION. A COPY OF THE DISCLOSURE OF INTEREST POLICY, ALONG WITH AN EXPLANATION AND QUESTIONNIARE, ARE SENT TO ALL TRUSTEES, EXECUTIVE STAFF, MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITY, SELECTED EMPLOYEES, AND VOLUNTEERS ANNUALLY. THE QUESTIONNIARE MUST BE COMPLETED AND RETURNED TO THE CHAIRMAN OF THE BOARD. A REPORT IS SUBMITTED TO THE BOARD CONCERNING ANY INTERESTS THAT ARE DISCLOSED. IN SITUATIONS WHERE A POTENTIAL CONFLICT IS FOUND, THE BOARD REVIEWS THE CIRCUMSTANCES BEFORE A VOTE OR DISCUSSION OF MATTERS INVOLVING INTERESTED PARTIES.
FORM 990, PART VI, SECTION B, LINE 15A
THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE ANY OFFICERS, DIRECTORS, OR TRUSTEES. THE BOARDS OF ANMED HEALTH FOUNDATION AND OF ANMED HEALTH ARE THE SAME BODY, AND COMPENSATION FOR THE FOUNDATION'S DIRECTOR IS REVIEWED ANNUALLY AND APPROVED BY THIS GOVERNING BODY.
FORM 990, PART VI, SECTION C, LINE 18
PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S EXECUTIVE OFFICES. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19
PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S EXECUTIVE OFFICE. COPIES OF THE FINANCIAL STATEMENTS ARE AVAILABLE ON A SECURE WEBSITE FOR BONDHOLDERS. PLEASE CONTACT THE EXECUTIVE OFFICE FOR DETAILS.
WORK HOURS DEVOTED TO A RELATED ORGANIZATION:
PART VII, SECTION A:
IN ADDITION TO THE HOURS DEVOTED TO THE FOUNDATION, THE OFFICERS OF THE ORGANIZATION WORK 50 HOURS PER WEEK FOR A RELATED ORGANIZATION.
BOARD MEMBER RELATED COMPENSATION:
FORM 990, PART VII, LINE 1:
IN ADDITION TO HIS SERVICES TO THE BOARD, DR. STEPHEN HAND IS COMPENSATED THROUGH HIS MEDICAL PRACTICE FOR SERVICES RENDERED TO THE HOSPITAL SYSTEM. ALL PAYMENTS TO HIM ON PART VII OF THE FORM 990 ARE FOR MEDICAL SERVICES. A PORTION OF THE COMPENSATION FOR DR. MICHAEL KUNKEL LISTED ON PART VII IS FOR MEDICAL SERVICES PERFORMED FOR A RELATED ORGANIZATION.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
LOSS FROM INVESTMENT IN SUBSIDIARIES -2,840,764. OTHER NET CHANGES OF SUBSIDIARIES, ELIMINATED IN CONSOLIDATION -38,583,141. TOTAL TO FORM 990, PART XI, LINE 5: -41,423,905.
CONSOLIDATED FINANCIAL STATEMENTS:
FORM 990, PART XI, LINE 2
THE ORGANIZATION RECEIVED AUDITED FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS WITH ANMED HEALTH ENTERPRISES, INC., ANMED HEALTH, AND THEIR CONTROLLED AND MAJORITY OWNED AFFILIATES. ALL SIGNIFICANT INTERCOMPANY ACCOUNTS AND TRANSACTIONS HAVE BEEN ELIMINATED.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.