Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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 | ||||
| (1)
Hallmark Health Services Inc |
222602523 | 9 | No | Yes | Yes | 0 | |||
| (2)
Hallmark Health Visiting Nurse Assoc & Hospice Inc |
042437064 | 9 | No | Yes | Yes | 0 | |||
| (3)
Hallmark Health Medical Associates Inc |
043140938 | 9 | No | Yes | Yes | 0 | |||
| (4)
North Suburban Long Term Care Inc |
222728437 | 9 | No | Yes | Yes | 0 | |||
| (5)
Savin Long Term Care Corporation |
043012616 | 9 | No | Yes | Yes | 0 | |||
| (6)
Hallmark Health System Inc |
042767880 | 3 | Yes | Yes | Yes | 0 | |||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 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.. | ||||||
| 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).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 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). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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.). | ||||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 1A | The Secretary of the governing body does not have a vote on the board. |
| Form 990 Part VI | 6 | The Corporation has one member - Hallmark Health Corporation - The Parent Corporation. |
| Form 990 Part VI | 7A | The Corporation has one member who elects the governing body. |
| Form 990 Part VI | 7B | The sole member The Parent has approval powers over actions of the governing body. |
| Form 990 Part VI | 11b | Form 990 was provided to the governing body for review and explanation prior to filling. |
| Form 990 Part VI | 12c | Annually, one or more of the officers of this corporation are given the conflict policy and are required to complete a disclosure form that is submitted to the office of the general counsel for review. The contents of the disclousure and the actions necessary to address conflicts are reviewed by the chair of the Parent Corporations governing body and its President. |
| Form 990 Part VI | 15ab | Annually, the Human Resources Commitee of the Parent Corporation comprised of independent directors, reviews the compensation of one or more of the Officers, and members of the Executive Leadership Team using data from an independent third party evaluation of comparable compensation data to assess and set compensation of one or more of the officers, and the Executive Leadership Team, of this corporation. The president and members of the Executive Leadership Team are paid by related organizations. |
| Form 990 Part VI | 18 | Documents are available for public inspection upon request to the Office of the General Counsel. |
| Form 990 Part VI | 19 | Documents are available for public inspection upon request to the Office of the General Counsel. |
| Form 990 Part XI | 5 | This amount reflects the discharge of debt from related organizations and rounding. |
| Form 990 Part VII | 1a | All employed Officers, Directors Key Employees work and average of 37.5 hours per week for this corporation and for other related corporations. |
| Form 990 Part VI Section A Line 1A The Secretary of the governing body does not have a vote on the board. Form 990 Part VI Section A Line 6 The Corporation has one member - Hallmark Health Corporation - The Parent Corporation. Form 990 Part VI Section A Line 7A The Corporation has one member who elects the governing body. Form 990 Part VI Section A Line 7B The sole member The Parent has approval powers over actions of the governing body. Form 990 Part VI Section B Line 11b Form 990 was provided to the governing body for review and explanation prior to filling. Form 990 Part VI Section B Line 12c Annually, one or more of the officers of this corporation are given the conflict policy and are required to complete a disclosure form that is submitted to the office of the general counsel for review. The contents of the disclousure and the actions necessary to address conflicts are reviewed by the chair of the Parent Corporations governing body and its President. Form 990 Part VI Section B Line 15ab Annually, the Human Resources Commitee of the Parent Corporation comprised of independent directors, reviews the compensation of one or more of the Officers, and members of the Executive Leadership Team using data from an independent third party evaluation of comparable compensation data to assess and set compensation of one or more of the officers, and the Executive Leadership Team, of this corporation. The president and members of the Executive Leadership Team are paid by related organizations. Form 990 Part VI Section C Line 18 Documents are available for public inspection upon request to the Office of the General Counsel. Form 990 Part VI Section C Line 19 Documents are available for public inspection upon request to the Office of the General Counsel. Form 990 Part XI Line 5 This amount reflects the discharge of debt from related organizations and rounding. Form 990 Part VII Section A Line 1a All employed Officers, Directors Key Employees work and average of 37.5 hours per week for this corporation and for other related corporations. |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |